# Acute Appendicitis — GCMD Library living collection

Everything in the library about acute appendicitis — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 29 cited statements

## Episodes
### Acute Management
- [Opioid Use in Pediatric Surgery](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297) — video · [machine version](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297.md)

### Surgical Management
- [Mini lap appy](https://library.globalcastmd.com/watch/mini-lap-appy-11943) — video · 4:50 · [machine version](https://library.globalcastmd.com/watch/mini-lap-appy-11943.md)

### Evidence & Research
- [Unanticipated consequences of COVID-19 pandemic policies on pediatric acute appendicitis surgery](https://library.globalcastmd.com/watch/unanticipated-consequences-of-covid-19-pandemic-policies-on-pediatric-acute-appendicitis-surgery-6837) — video · [machine version](https://library.globalcastmd.com/watch/unanticipated-consequences-of-covid-19-pandemic-policies-on-pediatric-acute-appendicitis-surgery-6837.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=0) Current opioid prescribing practices for common pediatric procedures (Ep 1)
- [3:17](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=197) Epidemiology of pediatric opioid deaths and prescribing patterns (Ep 1)
- [7:18](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=438) Buffalo intervention study results (Ep 1)
- [8:14](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=494) Gabapentin use in pediatric surgery (Ep 1)
- [10:55](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=655) TAP blocks and IV acetaminophen (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/unanticipated-consequences-of-covid-19-pandemic-policies-on-pediatric-acute-appendicitis-surgery-6837?t=0) COVID-19 Impact on Pediatric Appendicitis Presentation and Outcomes (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/mini-lap-appy-11943?t=0) Case presentation and room setup (Ep 3)
- [1:35](https://library.globalcastmd.com/watch/mini-lap-appy-11943?t=95) Port insertion and insufflation (Ep 3)
- [2:55](https://library.globalcastmd.com/watch/mini-lap-appy-11943?t=175) Mesenteric dissection (Ep 3)
- [3:50](https://library.globalcastmd.com/watch/mini-lap-appy-11943?t=230) Appendix stapling and inspection (Ep 3)
- [4:20](https://library.globalcastmd.com/watch/mini-lap-appy-11943?t=260) Specimen extraction and closure (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "The patient is a 16-year-old female who presented with a 24 hour history of increasing right lower quadrant pain." (clinical) [Ep 3 · 0:00](https://library.globalcastmd.com/watch/mini-lap-appy-11943?t=0)
- "Two ports are placed through a 1 centimeter umbilical incision, and a single 3 millimeter incision is made in the suprapubic area for the left hand retracting port." (clinical) [Ep 3 · 0:30](https://library.globalcastmd.com/watch/mini-lap-appy-11943?t=30)
- "The child weighs 65 kg and it is possible to use this technique in patients up to 100 kg." (clinical) [Ep 3 · 1:10](https://library.globalcastmd.com/watch/mini-lap-appy-11943?t=70)
- "A 1 centimeter incision is made within the umbilicus so that the scar will not be visible postoperatively." (clinical) [Ep 3 · 1:35](https://library.globalcastmd.com/watch/mini-lap-appy-11943?t=95)
- "The abdomen is insufflated to a pressure of 15 mmHg using a closed Veress needle technique in all cases." (clinical) [Ep 3 · 1:50](https://library.globalcastmd.com/watch/mini-lap-appy-11943?t=110)
- "A 4 millimeter trochar is inserted for a 4 millimeter 30 degree scope; in larger patients, a 5 millimeter 30 degree scope is often used." (clinical) [Ep 3 · 2:10](https://library.globalcastmd.com/watch/mini-lap-appy-11943?t=130)
- "A second trochar is inserted through the same incision but through a separate fascial defect for the 5 millimeter Maryland, hook cautery, and eventually the 5 millimeter stapler." (clinical) [Ep 3 · 2:30](https://library.globalcastmd.com/watch/mini-lap-appy-11943?t=150)
- "A 3 millimeter incision is made just above the pubic bone, below the pubic hairline, for a 3 millimeter Babcock which provides right angle retraction." (clinical) [Ep 3 · 2:45](https://library.globalcastmd.com/watch/mini-lap-appy-11943?t=165)
- "The appendix was mildly inflamed." (clinical) [Ep 3 · 3:05](https://library.globalcastmd.com/watch/mini-lap-appy-11943?t=185)
- "Hook cautery is used to take the appendiceal mesentery; there is significant energy spread and smoke, but this is acceptable because the appendix is being removed." (clinical) [Ep 3 · 3:10](https://library.globalcastmd.com/watch/mini-lap-appy-11943?t=190)
- "Monopolar cautery is used in this case; the dissection can also be done using a 3 millimeter sealer or other energy devices, but a reusable hook cautery is generally adequate." (clinical) [Ep 3 · 3:30](https://library.globalcastmd.com/watch/mini-lap-appy-11943?t=210)
- "It is important to not leave the appendiceal artery patent next to the appendix when using the 5 millimeter stapler, as sometimes the vessel is so small the staples do not adequately capture it." (clinical) [Ep 3 · 3:45](https://library.globalcastmd.com/watch/mini-lap-appy-11943?t=225)
- "In patients with a thicker mesentery, the staple load can be used for the mesentery, although the hook cautery technique works quite well." (clinical) [Ep 3 · 4:05](https://library.globalcastmd.com/watch/mini-lap-appy-11943?t=245)
- "The base of the appendix is grasped and compressed to ensure it is not too thick for the 5 millimeter stapler." (clinical) [Ep 3 · 4:15](https://library.globalcastmd.com/watch/mini-lap-appy-11943?t=255)
- "The 5 millimeter stapler is compressed with checking to ensure excellent alignment of the two ends; if necessary, the stapler can be reapplied." (clinical) [Ep 3 · 4:25](https://library.globalcastmd.com/watch/mini-lap-appy-11943?t=265)
- "There is occasionally some very mild oozing at the staple line, which is insignificant." (clinical) [Ep 3 · 4:35](https://library.globalcastmd.com/watch/mini-lap-appy-11943?t=275)
- "The 5 millimeter trocar is removed and a 5 millimeter endoscopic bag is inserted through the fascial defect, opened in the abdominal cavity, and the appendix is placed within it." (clinical) [Ep 3 · 4:20](https://library.globalcastmd.com/watch/mini-lap-appy-11943?t=260)
- "The bag is removed through the umbilicus; if necessary, the fascial defect is widened or the two fascial defects are joined using a Kelly clamp, but the patient remains with a 1 centimeter skin incision." (clinical) [Ep 3 · 4:40](https://library.globalcastmd.com/watch/mini-lap-appy-11943?t=280)
- "A retrospective cohort study was conducted at the Hospital for Sick Children in Toronto comparing pre-pandemic and pandemic periods for acute appendicitis cases." — Cecilia Gigena (host_summary) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/unanticipated-consequences-of-covid-19-pandemic-policies-on-pediatric-acute-appendicitis-surgery-6837?t=0)
- "The study included 1,107 patients total: 491 from the pre-pandemic period and 616 from the pandemic period." — Cecilia Gigena (host_summary) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/unanticipated-consequences-of-covid-19-pandemic-policies-on-pediatric-acute-appendicitis-surgery-6837?t=0)
- "The pandemic period had significantly more complicated appendicitis compared to the pre-pandemic period." — Cecilia Gigena (host_summary) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/unanticipated-consequences-of-covid-19-pandemic-policies-on-pediatric-acute-appendicitis-surgery-6837?t=0)
- "The pandemic period had more readmissions rates compared to the pre-pandemic period." — Cecilia Gigena (host_summary) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/unanticipated-consequences-of-covid-19-pandemic-policies-on-pediatric-acute-appendicitis-surgery-6837?t=0)
- "Patients from the pre-pandemic period were significantly younger than those during the pandemic." — Cecilia Gigena (host_summary) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/unanticipated-consequences-of-covid-19-pandemic-policies-on-pediatric-acute-appendicitis-surgery-6837?t=0)
- "Over the past 18 years, 9,000 children and adolescents have died from opioids." (host_summary) [Ep 1 · 3:47](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=227)
- "Opioid mortality rate in children has increased threefold." (host_summary) [Ep 1 · 4:00](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=240)
- "In kids zero to four years old, there is a 7% death rate from kids getting opioids." (host_summary) [Ep 1 · 4:10](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=250)
- "25% of pediatric opioid deaths have been homicides." (host_summary) [Ep 1 · 4:18](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=258)
- "81% of pediatric opioid deaths are adolescent." (host_summary) [Ep 1 · 4:23](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=263)
- "The heroin death rate has increased 485%." (host_summary) [Ep 1 · 4:27](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=267)
- "Kurt Heist says the return to system or coming back to the hospital or call backs are the same for those with or without opioids, if the Tylenol motrin dosings are scheduled and given in advance." (host_summary) [Ep 1 · 4:45](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=285)
- "In a study from 2006 to 2014, 68% of patients were prescribed opioids." (host_summary) [Ep 1 · 5:20](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=320)
- "Adult general surgeons tended to give more opioids than pediatric surgeons." (host_summary) [Ep 1 · 5:28](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=328)
- "The opioid group has increased ED visits for constipation." (host_summary) [Ep 1 · 5:35](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=335)
- "In umbilical hernia data from 2012 to 2015, 52% of 4,000 patients received post-op opioids." (host_summary) [Ep 1 · 5:50](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=350)
- "Six years old or older patients tended to get more opioids than younger kids." (host_summary) [Ep 1 · 6:10](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=370)
- "Southern US was more problematic than Northeast in opioid prescribing." (host_summary) [Ep 1 · 6:18](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=378)
- "Duration of opioid prescribing: less than three days was 50%, four to 10 days was almost 50%, and greater than 10 days was 4%." (host_summary) [Ep 1 · 6:25](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=385)
- "After the Buffalo intervention, opioid prescribing at discharge for appendectomy dropped from 84% to 7%." (host_summary) [Ep 1 · 7:45](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=465)
- "After the Buffalo intervention, acetaminophen prescribing at discharge increased from 31% to 94%." (host_summary) [Ep 1 · 7:58](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=478)
- "After the Buffalo intervention, ibuprofen prescribing at discharge increased from 58% to 86%." (host_summary) [Ep 1 · 8:05](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=485)
- "After the Buffalo intervention, automatic Miralax at discharge dropped from 77% to 47% as there were fewer problems with constipation." (host_summary) [Ep 1 · 8:10](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=490)
- "For acute appendicitis, the speaker's group does not prescribe opioids at discharge and has not had problems with patients calling back." (clinical) [Ep 1 · 0:53](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=53)
- "For umbilical hernia repair, patients are put on scheduled acetaminophen and ibuprofen alternating every four hours when awake." (clinical) [Ep 1 · 1:53](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=113)
- "Julie Rios gives fewer narcotics to adult patients, using acetaminophen and ibuprofen, and sends them home with a few oxycodone tablets as breakthrough for one or two days." — Julie Rios (clinical) [Ep 1 · 2:47](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=167)
- "Gabapentin dose for younger kids is 5 milligrams per kilo per dose TID for three to five days, according to Dr. Heist." (host_summary) [Ep 1 · 9:08](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=548)
- "Gabapentin is used at 300 milligrams TID in bigger kids." (clinical) [Ep 1 · 8:38](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=518)
- "Gabapentin is continued even if patients are NPO, as part of ERAS protocol with very short NPO times." (clinical) [Ep 1 · 9:34](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=574)
- "In bariatric patients using gabapentin, postop day one discharge increased from about 20% to 50 plus percent." (clinical) [Ep 1 · 10:31](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=631)
- "TAP blocks involve medicine that goes intercostally with a catheter that numbs the abdominal wall, allowing patients to get up, move, and pass gas the same day without narcotic medication." — Julie Rios (clinical) [Ep 1 · 11:47](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=707)
- "IV Tylenol is very expensive compared to per rectum Tylenol." (clinical) [Ep 1 · 12:38](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=758)
- "IV Tylenol is no more or less efficacious than per rectum Tylenol." (clinical) [Ep 1 · 13:00](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=780)
- "IV Tylenol used to be hundreds of dollars a dose and is now maybe 20 or 30 dollars a dose." (clinical) [Ep 1 · 13:33](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=813)
- "Per rectum Tylenol works just as well as IV with the same bioavailability, according to pharmacy literature on kinetics." (clinical) [Ep 1 · 13:48](https://library.globalcastmd.com/watch/opioid-use-in-pediatric-surgery-2297?t=828)

## Changelog
- Sep 25: 3 items added automatically

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