# Aerodigestive / ENT — GCMD Library living collection

Also covered as: esophageal atresia · tracheoesophageal fistula · dysphagia · tracheomalacia · eosinophilic esophagitis · aspiration · laryngeal cleft · subglottic stenosis

Experts: Dr. Em Gootee, Dr. Todd Ponsky, Dr. Bob Wood, Dr. Phil Putnam

Updated: n/a · 28 episodes · 556 cited statements

## Episodes
### Foundations
- [QUAD #22: What is CHARGE syndrome? with Dr. Catherine Hart](https://library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458) — video · 0:59 · [machine version](https://library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458.md)

### Diagnosis & Workup
- [Aerodigestive & Esophageal Surgery: Dual Endoscopy Discussion](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-dual-endoscopy-discussion-1038) — video · 2:22 · [machine version](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-dual-endoscopy-discussion-1038.md)
- [Aerodigestive & Esophageal Surgery: Aspiration in TEFs](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039) — video · 5:28 · [machine version](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039.md)

### Acute Management
- [QUAD #7 Anesthesia for Thoracoscopic Techniques with Dr. Nathaniel Tighe](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115) — video · 7:35 · [machine version](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115.md)

### Medical Management
- [Pediatric Gastroesophageal Reflux Disease](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359) — podcast · 81:04 · [machine version](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359.md)
- [Gastroesophageal Reflux Disease](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289) — podcast · 81:04 · [machine version](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289.md)
- [QUAD #25: Medical Management of Minor Laryngeal Clefts with Dr. Greg Burg](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773) — video · 7:11 · [machine version](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773.md)

### Surgical Management
- [Pediatric Tracheostomy in a 7 year old child Dr. Tamer Ashraf Wafa](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151) — video · 2:53 · [machine version](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151.md)
- [Laryngeal Clefts](https://library.globalcastmd.com/watch/laryngeal-clefts-4226) — video · 14:20 · [machine version](https://library.globalcastmd.com/watch/laryngeal-clefts-4226.md)
- [Laryngotracheal Stenosis](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406) — video · 16:20 · [machine version](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406.md)
- [QUAD #1: Cervical Tracheopexy with Dr. Alessandro de Alarcon](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779) — video · 5:26 · [machine version](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779.md)
- [QUAD #2 Thoracoscopic Tracheopexy with Dr. Aaron Garrison](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919) — video · 7:36 · [machine version](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919.md)
- [QUAD #4: Surgical Management of Button Battery & Caustic Ingestion with Dr. Aaron Garrison](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088) — video · 8:10 · [machine version](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088.md)
- [QUAD #6 Slide Tracheoplasty for TEF, Otolaryngology Approach with Dr. Mike Rutter](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114) — video · 7:37 · [machine version](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114.md)
- [QUAD #20: Endoscopic Repair of Minor Laryngeal Clefts with Dr. Catherine Hart](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373) — video · 6:01 · [machine version](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373.md)

### Complications
- [QUAD #5 Pharyngeal Scar Management with Dr. Doug von Allmen](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116) — video · 7:12 · [machine version](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116.md)

### Evidence & Research
- [Article of Interest: Optimal Timing of Tracheostomy in Injured Adolescents](https://library.globalcastmd.com/watch/article-of-interest-optimal-timing-of-tracheostomy-in-injured-adolescents-5788) — video · 1:34 · [machine version](https://library.globalcastmd.com/watch/article-of-interest-optimal-timing-of-tracheostomy-in-injured-adolescents-5788.md)
- [Quick Literature Updates Episode 8](https://library.globalcastmd.com/watch/quick-literature-updates-episode-8-6713) — video · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-episode-8-6713.md)
- [Esophageal Surveillance Practices in Esophageal Atresia Patients](https://library.globalcastmd.com/watch/esophageal-surveillance-practices-in-esophageal-atresia-patients-6844) — video · [machine version](https://library.globalcastmd.com/watch/esophageal-surveillance-practices-in-esophageal-atresia-patients-6844.md)
- [Tracheobronchopexy to Avoid Tracheostomy in Esophageal Atresia Patients With Severe Life-Threatening Tracheobronchomalacia](https://library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435) — video · 0:50 · [machine version](https://library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435.md)
- [Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2025](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786) — podcast · 16:35 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786.md)
- [Surgeon annual volume impacts recurrence rates of pediatric inguinal hernia repairs: A multi-institutional study](https://library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554) — video · 0:54 · [machine version](https://library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554.md)

### Case-Based Learning
- [Aerodigestive & Esophageal Surgery - The Unsalvageable Esophagus & Cases](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738) — video · 101:09 · [machine version](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738.md)
- [Aerodigestive & Esophageal Surgery - Difficult Tracheal Esophageal Fistula](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739) — video · 120:59 · [machine version](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739.md)
- [TEF Presentations (Extended): Aerodigestive & Esophageal Surgery](https://library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037) — video · 108:11 · [machine version](https://library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037.md)

### In-Depth Reviews
- [Aerodigestive Management of Pediatric Aspiration - FULL SHOW](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796) — video · 157:09 · [machine version](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796.md)
- [QUAD #27 - Multidisciplinary - How Do Teams Enhance Outcomes by the CCHMC ADEC Team](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201) — video · 10:19 · [machine version](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201.md)

### Patient & Family Education
- [QUAD Conference Commercial](https://library.globalcastmd.com/watch/quad-conference-commercial-5388) — video · 1:22 · [machine version](https://library.globalcastmd.com/watch/quad-conference-commercial-5388.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=0) Introduction and Initial Workup of Infant Reflux (Ep 8)
- [5:00](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=300) Diagnostic Approach and Eosinophilic Esophagitis (Ep 8)
- [11:40](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=700) Medical Management and Role of Testing (Ep 8)
- [20:00](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1200) NICU Patients and Feeding Tube Management (Ep 8)
- [30:00](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1800) Indications for Fundoplication and Gastric Emptying (Ep 8)
- [40:00](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2400) pH Impedance Testing and Rome IV Criteria (Ep 8)
- [50:00](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3000) Surgical Technique: The Perfect Nissen (Ep 8)
- [60:00](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3600) Post-Fundoplication Complications and Management (Ep 8)
- [70:00](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=4200) Advanced Options and Rumination Syndrome (Ep 8)
- [0:00](https://library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554?t=0) Surgeon Volume and Inguinal Hernia Recurrence (Ep 28)
- [0:00](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=0) Introduction and Diagnostic Challenges (Ep 22)
- [1:19](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=79) Surgical Technique for Endoscopic Cleft Repair (Ep 22)
- [3:10](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=190) Postoperative Care and Comparative Outcomes (Ep 22)
- [5:04](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=304) Summary and Conclusion (Ep 22)
- [0:00](https://library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458?t=0) CHARGE Syndrome Definition and Diagnostic Criteria (Ep 23)
- [0:00](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=0) Introduction and Conference Context (Ep 24)
- [0:40](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=40) Case Presentation and Bronchoscopic Findings (Ep 24)
- [1:52](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=112) Assessment Framework for Cleft Severity (Ep 24)
- [3:42](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=222) Medical Management Strategies (Ep 24)
- [4:49](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=289) Pulmonary Therapies and Monitoring (Ep 24)
- [6:20](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=380) Summary and Conclusion (Ep 24)
- [0:00](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=0) Introduction and Guest Introductions (Ep 1)
- [2:49](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=169) Initial Workup of Infant with Vomiting and Respiratory Symptoms (Ep 1)
- [10:47](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=647) Medical Management Strategies and Testing Limitations (Ep 1)
- [17:11](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=1031) Role of Upper GI and Anatomic Evaluation (Ep 1)
- [24:25](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=1465) NICU Patients and Feeding Tube Decisions (Ep 1)
- [34:57](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=2097) Diagnostic Testing: When and Why (Ep 1)
- [40:10](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=2410) Rome IV Criteria and Long-term PPI Use (Ep 1)
- [44:50](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=2690) Eosinophilic Esophagitis Recognition and Management (Ep 1)
- [50:10](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3010) Neurologically Impaired Patients and Fundoplication Indications (Ep 1)
- [55:37](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3337) The Perfect Fundoplication: Minimal Dissection Technique (Ep 1)
- [61:14](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3674) Post-Fundoplication Wretching Management (Ep 1)
- [68:32](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=4112) Failed Fundoplication: Evaluation and Redo Considerations (Ep 1)
- [73:37](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=4417) Alternative Surgical Options and Rumination Syndrome (Ep 1)
- [77:53](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=4673) Rumination Syndrome Recognition (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=0) Long-gap esophageal atresia: initial case and management options (Ep 2)
- [13:20](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=800) Stricture management and anti-reflux timing (Ep 2)
- [26:40](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=1600) Redo esophageal surgery: 2-year-old with multiple thoracotomies (Ep 2)
- [40:00](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=2400) Esophageal stents and airway compression (Ep 2)
- [60:00](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=3600) High cervical stricture with intact distal esophagus (Ep 2)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "The vast majority of kids who have vomiting, respiratory symptoms, and wheezing are more likely to have oropharyngeal dysphagia and aspiration during swallowing than gastroesophageal reflux" — Rachel Rosen (clinical) [Ep 8 · 3:23](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=203)
- "The peak age of reflux is between 4 and 6 months of age" — Rachel Rosen (epidemiological) [Ep 8 · 4:32](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=272)
- "Proton pump inhibitors are not beneficial in children under the age of 1 because these kids reflux non-acidic gastric content (milk)" — Rachel Rosen (clinical) [Ep 8 · 5:26](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=326)
- "Normal gastric emptying of infants means they still have milk in their stomach for up to 2 to 3 hours; acid production only starts after the 3 hour mark" — Rachel Rosen (clinical) [Ep 8 · 5:45](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=345)
- "Studies have shown both with H2 blockers and PPIs you can get sepsis, UTIs, necrotizing enterocolitis, pneumonias, pharyngitis, upper respiratory infections, and C. diff in young infants" — Rachel Rosen (clinical) [Ep 8 · 7:21](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=441)
- "In kids under the age of 5 presenting with respiratory symptoms, eosinophilic esophagitis is found in about 10% when endoscopy is performed" — Rachel Rosen (epidemiological) [Ep 8 · 9:53](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=593)
- "The number one presentation of eosinophilic esophagitis in kids under age 5 is chronic cough, followed by vomiting or failure to thrive" — Rachel Rosen (clinical) [Ep 8 · 9:41](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=581)
- "You really need to scope every kid before they would get a Nissen because you don't want to wrap a kid who has eosinophilic esophagitis" — Rachel Rosen (guideline) [Ep 8 · 10:54](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=654)
- "The most likely allergen in eosinophilic esophagitis is dairy in about 60 to 70% of kids" — Rachel Rosen (epidemiological) [Ep 8 · 11:57](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=717)
- "Macrolides like erythromycin are motilin agonists that make the antrum contract and help with vomiting, plus have anti-inflammatory benefits for the airway and lungs" — Rachel Rosen (clinical) [Ep 8 · 16:28](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=988)
- "There are no great normal values for the number of reflux episodes in pediatric patients, making pH impedance interpretation difficult" — Rachel Rosen (clinical) [Ep 8 · 17:48](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1068)
- "Reflux is rarely a cause of failure to thrive and respiratory symptoms in infants, especially at 6 months of age when reflux should be improving as solid food is introduced" — Rachel Rosen (opinion) [Ep 8 · 19:18](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1158)
- "An upper GI is not a good study for reflux diagnosis; it only helps identify anatomical problems in about 4% of patients" — Whit Holcomb (clinical) [Ep 8 · 22:38](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1358)
- "The majority of kids with oropharyngeal dysphagia will outgrow it by 3 to 4 months of age" — Rachel Rosen (clinical) [Ep 8 · 28:21](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1701)
- "About 75% of NICU patients with dysphagia managed with NG tubes will not need to go on to gastrostomy" — Rachel Rosen (epidemiological) [Ep 8 · 28:42](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1722)
- "When gastrostomy goes in for children who aspirate from oropharyngeal dysphagia, their rates of hospitalization are about 15 times higher than if you just fed them by mouth" — Rachel Rosen (epidemiological) [Ep 8 · 29:37](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1777)
- "Nasogastric tubes in neonates under 3 months of age don't come out that frequently" — Rachel Rosen (clinical) [Ep 8 · 31:13](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1873)
- "If symptoms go away with nasojejunal feeds, reflux likely is playing a role and Nissen may be an option" — Rachel Rosen (clinical) [Ep 8 · 34:09](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2049)
- "Kids who wretch preoperatively are the most miserable post-Nissen because they wretch a lot postoperatively too" — Rachel Rosen (clinical) [Ep 8 · 35:20](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2120)
- "Rome IV criteria define three categories: non-erosive reflux disease (NERD) with abnormal acid burden, reflux hypersensitivity with normal acid but symptom correlation, and functional heartburn with no correlation" — Rachel Rosen (guideline) [Ep 8 · 40:54](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2454)
- "New GERD guidelines recommend treating with PPI for 2 months then attempting to wean, with goal of weaning ideally 2 times per year" — Rachel Rosen (guideline) [Ep 8 · 44:04](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2644)
- "If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term" — Rachel Rosen (clinical) [Ep 8 · 45:31](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2731)
- "In a prospective randomized trial of 107 patients using minimal mobilization technique, neither group required a redo fundoplication for transmigration" — Whit Holcomb (clinical) [Ep 8 · 46:40](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2800)
- "The primary reason for redo fundoplication historically was transmigration of the wrap into the chest" — Whit Holcomb (epidemiological) [Ep 8 · 47:08](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2828)
- "By doing minimal mobilization and placing sutures between esophagus and crura, transmigration rate was reduced from 12% to 5%" — Whit Holcomb (clinical) [Ep 8 · 57:32](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3452)
- "With minimal mobilization alone (no sutures), there was zero transmigration in prospective trial, with only one wrap loosening" — Whit Holcomb (clinical) [Ep 8 · 58:23](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3503)
- "Kids who aspirate during swallowing and then get a Nissen have saliva pool in their esophagus over the Nissen, leading to gagging, wretching, and coughing" — Rachel Rosen (clinical) [Ep 8 · 49:02](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2942)
- "Blenderized feeds using table food migrate to the antrum away from the LES and cardia, reducing reflux symptoms in neurologically impaired children" — Rachel Rosen (clinical) [Ep 8 · 52:39](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3159)
- "Pyloric Botox works not only for delayed emptying but also with the sensory component that triggers wretching" — Rachel Rosen (clinical) [Ep 8 · 54:19](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3259)
- "Botox doesn't reliably improve gastric emptying but helps significantly with wretching, possibly by affecting sensory mechanisms" — Rachel Rosen (clinical) [Ep 8 · 68:18](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=4098)
- "Post-fundoplication patients should be imaged both by putting barium through the G-tube and giving barium from above via nasoesophageal tube to assess esophageal emptying" — Rachel Rosen (clinical) [Ep 8 · 62:02](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3722)
- "A Cincinnati study showed blenderized feeds are effective therapy for treatment of post-fundoplication wretching" — Rachel Rosen (clinical) [Ep 8 · 63:11](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3791)
- "Using esophageal bougie at time of fundoplication has resulted in very little need for postoperative dilation" — Whit Holcomb (clinical) [Ep 8 · 63:46](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3826)
- "Gastric pacing may work through sensory effects rather than motility improvement, as some patients improve without motility changes" — Rachel Rosen (clinical) [Ep 8 · 67:38](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=4058)
- "Rates of reflux post-Nissen are between 10 and 20 reflux episodes per 24 hour period, which is considered acceptable" — Rachel Rosen (clinical) [Ep 8 · 71:39](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=4299)
- "Patients who ruminate describe vomiting 50-100 times a day, typically within minutes of starting a meal or the hour after, and esophageal motility shows simultaneous gastric contraction with bolus movement into esophagus" — Rachel Rosen (clinical) [Ep 8 · 78:40](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=4720)
- "Patients who ruminate continue to do this even with a wrap in place, making fundoplication ineffective" — Rachel Rosen (clinical) [Ep 8 · 79:31](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=4771)
- "Heller et al. published a multi-institutional study in the Journal of Pediatric Surgery in 2025" — Jill Knepprath (epidemiological) [Ep 28 · 0:10](https://library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554?t=10)
- "Inguinal hernias repaired by lower volume surgeons had a 1.5 fold increase in the odds of recurrence" — Jill Knepprath (epidemiological) [Ep 28 · 0:22](https://library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554?t=22)
- "There was no difference in recurrence rates for open repairs based on surgeon volume" — Jill Knepprath (epidemiological) [Ep 28 · 0:30](https://library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554?t=30)
- "Laparoscopic repairs done by lower volume surgeons had a 3.3 fold increase in the odds of recurrence" — Jill Knepprath (epidemiological) [Ep 28 · 0:35](https://library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554?t=35)
- "The authors recommend maintaining a high volume of laparoscopic repairs, and if that's not possible, to seek help from a higher volume surgeon" — Jill Knepprath (guideline) [Ep 28 · 0:44](https://library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554?t=44)
- "Flexible bronchoscopy can appear completely normal in a child with a type 1 laryngeal cleft that is visible on rigid bronchoscopy" — Catherine Hart (clinical) [Ep 22 · 0:53](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=53)
- "Combined rigid and flexible bronchoscopy evaluations are complementary and necessary to avoid missing laryngeal clefts" — Catherine Hart (clinical) [Ep 22 · 1:09](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=69)
- "Surgical indications for laryngeal cleft repair include ongoing respiratory symptoms, aspiration, failure to thrive, or recurrent pulmonary infections when other treatments have failed" — Catherine Hart (guideline) [Ep 22 · 1:22](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=82)
- "The goal of endoscopic cleft repair is to remove the interarytenoid mucosa to create two raw surfaces that are then sewn together" — Em Gootee (clinical) [Ep 22 · 1:45](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=105)
- "Edge inversion is essential for successful closure regardless of whether mass closure or layered closure technique is used" — Catherine Hart (clinical) [Ep 22 · 1:52](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=112)
- "Taking suture bites too deeply results in inverted edges and continued clinical problems" — Em Gootee (clinical) [Ep 22 · 2:05](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=125)
- "Interarytenoid mucosa can be resected using either laser or cold steel" — Em Gootee (clinical) [Ep 22 · 2:23](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=143)
- "Cold steel resection is preferred for minor clefts because it is simpler to set up, faster, and eliminates the risk of laser fire" — Catherine Hart (opinion) [Ep 22 · 2:30](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=150)
- "Complete demucosalization of the apex is critical; incomplete demucosalization results in a persistent hole at the apex and continued aspiration" — Em Gootee (clinical) [Ep 22 · 2:42](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=162)
- "Closure typically uses PDS suture on an RB1 or P3 needle depending on child size, with 2-3 interrupted sutures placed" — Catherine Hart (clinical) [Ep 22 · 2:56](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=176)
- "Epiglottic folds are released after suturing to create additional space" — Em Gootee (clinical) [Ep 22 · 3:01](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=181)
- "Postoperative protocol includes overnight observation on an airway unit, continuation of preoperative diet until follow-up, and repeat video swallow study and endoscopy at 6-8 weeks" — Catherine Hart (guideline) [Ep 22 · 3:10](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=190)
- "Surgical failure is not super common but can occur, often due to incomplete demucosalization at the apex resulting in healing at the top with a gap at the back" — Catherine Hart (clinical) [Ep 22 · 3:29](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=209)
- "Layered closure technique (closing anterior and posterior portions separately) is more reasonable for type 2 or 3 clefts but seems like excessive effort for minor clefts" — Catherine Hart (opinion) [Ep 22 · 3:46](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=226)
- "Conservative management achieves resolution over time in 51% of children with laryngeal clefts" — Catherine Hart (epidemiological) [Ep 22 · 4:09](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=249)
- "Injection laryngoplasty achieves symptom improvement in two-thirds of children and resolution in one-third" — Catherine Hart (epidemiological) [Ep 22 · 4:24](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=264)
- "Surgical cleft closure achieves symptom improvement in almost 80% of children and resolution in 70%" — Em Gootee (epidemiological) [Ep 22 · 4:31](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=271)
- "Surgical closure carries a slightly higher risk of complications compared to conservative management" — Em Gootee (clinical) [Ep 22 · 4:36](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=276)
- "Reported surgical complications include laryngeal scarring, supraglottic infections, and lacerations, though most complications are not terrible" — Catherine Hart (clinical) [Ep 22 · 4:45](https://library.globalcastmd.com/watch/quad-20-endoscopic-repair-of-minor-laryngeal-clefts-with-dr-catherine-hart-9373?t=285)
- "CHARGE acronym stands for coloboma, heart defects, atresia of the choana, retardation of growth and development, genital and/or urinary anomalies, and ear malformations" (clinical) [Ep 23 · 0:00](https://library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458?t=0)
- "CHARGE syndrome is caused by a CHD7 mutation on chromosome 8" — Catherine Hart (clinical) [Ep 23 · 0:11](https://library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458?t=11)
- "A population of children with CHARGE syndrome will have a negative test for CHD7" — Catherine Hart (clinical) [Ep 23 · 0:11](https://library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458?t=11)
- "CHARGE syndrome can be diagnosed based on clinical criteria even without CHD7 mutation" — Catherine Hart (clinical) [Ep 23 · 0:20](https://library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458?t=20)
- "Diagnosis requires at least two major criteria" (guideline) [Ep 23 · 0:24](https://library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458?t=24)
- "Major criteria are coloboma, choanal atresia or cleft palate, characteristic ear abnormalities, and cranial nerve abnormalities" (guideline) [Ep 23 · 0:28](https://library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458?t=28)
- "Definitive clinical diagnosis requires either 3 major features and at least 1 minor feature, or 2 major features and 2 minor features, or CHD7 mutation" — Catherine Hart (guideline) [Ep 23 · 0:41](https://library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458?t=41)
- "Flexible bronchoscopy is quite limited in evaluating a cleft unless it's a major cleft" — Em Gootee (clinical) [Ep 24 · 0:54](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=54)
- "The patient had a very inflammatory pattern on bronchoalveolar lavage" — Greg Burg (clinical) [Ep 24 · 1:34](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=94)
- "The patient did not have any lipid-laden macrophages despite being orally fed" — Greg Burg (clinical) [Ep 24 · 1:34](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=94)
- "Respiratory culture showed predominantly upper airway flora and two candidal species in the mucopurulent bronchitis" — Em Gootee (clinical) [Ep 24 · 1:44](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=104)
- "Management decisions for clefts depend heavily on the degree of aspiration" — Greg Burg (clinical) [Ep 24 · 1:52](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=112)
- "Patients with significant tracheobronchomalacia or upper airway obstruction may generate greater respiratory forces that push more air across the glottis and increase aspiration risk" — Greg Burg (clinical) [Ep 24 · 2:37](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=157)
- "If a child has a deepened interarytenoid notch with aspiration evidence on BAL or other studies and has bronchiectasis, clinicians are inclined to repair the notch" — Greg Burg (clinical) [Ep 24 · 3:27](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=207)
- "For patients with an interarytenoid notch and genetic components with concerns about central swallowing control, a brain MRI may be checked" — Greg Burg (clinical) [Ep 24 · 3:42](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=222)
- "Many patients do well with some form of thickening, pacing, and volume modification for safe swallowing" — Greg Burg (clinical) [Ep 24 · 4:04](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=244)
- "Aspiration can occur from three locations: things that start in the upper airway, things put in the upper airway, and things that come up from the GI system" — Greg Burg (clinical) [Ep 24 · 4:20](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=260)
- "Pulmonary therapies for aspiration are mostly considered reactive band-aid therapies" — Em Gootee (opinion) [Ep 24 · 4:49](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=289)
- "Inhaled steroids may be tried to reduce inflammation in aspiration patients" — Greg Burg (clinical) [Ep 24 · 4:54](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=294)
- "Chronic macrolide therapy can be used as an anti-neutrophilic agent, derived from cystic fibrosis literature" — Em Gootee (clinical) [Ep 24 · 4:57](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=297)
- "Saline is used to thin out secretions in aspiration patients" — Em Gootee (clinical) [Ep 24 · 4:57](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=297)
- "Albuterol may be used to bronchodilate if there is a reactive airway component to aspiration pneumonitis" — Greg Burg (clinical) [Ep 24 · 5:06](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=306)
- "For patients with significant tracheomalacia, ipratropium may be used over albuterol" — Em Gootee (clinical) [Ep 24 · 5:14](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=314)
- "Airway clearance augmentation may be needed for neurodevastated or musculoskeletally limited patients who lack a good cough or cannot clear their airways" — Greg Burg (clinical) [Ep 24 · 5:19](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=319)
- "Vaccination against respiratory illnesses is recommended for patients at risk for aspiration" — Greg Burg (guideline) [Ep 24 · 5:41](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=341)
- "Reducing environmental hazards including smoke exposure is recommended for aspiration patients" — Greg Burg (guideline) [Ep 24 · 5:41](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=341)
- "For non-operative monitoring, pulmonologists reassess clinical symptoms, hospitalization frequency, response to interventions, and may re-scope patients to reassess swallowing" — Greg Burg (clinical) [Ep 24 · 6:04](https://library.globalcastmd.com/watch/quad-25-medical-management-of-minor-laryngeal-clefts-with-dr-greg-burg-9773?t=364)
- "The vast majority of kids who have vomiting, respiratory symptoms, wheezing are more likely to have oropharyngeal dysphagia and aspiration during swallowing than gastroesophageal reflux" — Rachel Rosen (clinical) [Ep 1 · 3:23](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=203)
- "The peak age of reflux is between 4 and 6 months of age" — Rachel Rosen (epidemiological) [Ep 1 · 4:18](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=258)
- "Proton pump inhibitors are not beneficial in children under the age of 1 because these kids reflux non-acidic gastric content" — Rachel Rosen (clinical) [Ep 1 · 5:26](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=326)
- "Babies reflux milk and still have milk in their stomach for up to 2 to 3 hours after feeding; acid production only starts at the 3 hour mark" — Rachel Rosen (clinical) [Ep 1 · 5:39](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=339)
- "Studies have shown both with H2 blockers and PPIs you can get sepsis, UTIs, necrotizing enterocolitis, pneumonias, pharyngitis, upper respiratory infections, and C. diff in young children" — Rachel Rosen (clinical) [Ep 1 · 7:21](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=441)
- "In kids under the age of 5 presenting with respiratory symptoms, eosinophilic esophagitis is found in about 10% when endoscopy is performed" — Rachel Rosen (epidemiological) [Ep 1 · 9:53](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=593)
- "The number one presentation of eosinophilic esophagitis in kids under age 5 is chronic cough" — Rachel Rosen (clinical) [Ep 1 · 9:27](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=567)
- "In older kids, eosinophilic esophagitis presents with chest pain, food impactions, and dysphagia" — Rachel Rosen (clinical) [Ep 1 · 10:08](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=608)
- "The most likely food allergen in eosinophilic esophagitis is dairy, affecting 60 to 70% of kids" — Rachel Rosen (epidemiological) [Ep 1 · 11:57](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=717)
- "There is now a category of proton pump inhibitor responsive eosinophilic esophagitis, so PPIs can treat allergic esophageal disease" — Rachel Rosen (clinical) [Ep 1 · 11:32](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=692)
- "You should never wrap a kid who has eosinophilic esophagitis" — Rachel Rosen (clinical) [Ep 1 · 10:54](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=654)
- "The majority of kids with oropharyngeal dysphagia will outgrow it by 3 to 4 months of age" — Rachel Rosen (clinical) [Ep 1 · 28:21](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=1701)
- "About 75% of NICU babies with dysphagia will get the NG tube out and not need to go on to gastrostomy" — Rachel Rosen (epidemiological) [Ep 1 · 28:42](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=1722)
- "When gastrostomy goes in for children who aspirate from oropharyngeal dysphagia, their rates of hospitalization are about 15 times higher than if you just fed them by mouth" — Rachel Rosen (clinical) [Ep 1 · 29:37](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=1777)
- "An upper GI is not a good study for reflux; it's useful for identifying anatomical problems which occur in about 4% of patients" — Whit Holcomb (clinical) [Ep 1 · 22:32](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=1352)
- "Macrolides like erythromycin are motilin agonists that make the antrum contract and help with vomiting, plus provide anti-inflammatory benefit for airways" — Rachel Rosen (clinical) [Ep 1 · 16:28](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=988)
- "You have to watch out for development of pyloric stenosis when using macrolides in preemies" — Rachel Rosen (clinical) [Ep 1 · 37:43](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=2263)
- "Rome IV criteria define three categories: non-erosive reflux disease (abnormal acid burden, normal scope), reflux hypersensitivity (normal acid burden but symptoms correlate with reflux), and functional heartburn (no correlation between symptoms and reflux)" — Rachel Rosen (guideline) [Ep 1 · 40:54](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=2454)
- "New GERD guidelines recommend treating for 2 months with PPIs then attempting to wean, ideally trying to wean 2 times a year" — Rachel Rosen (guideline) [Ep 1 · 44:04](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=2644)
- "If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term" — Rachel Rosen (clinical) [Ep 1 · 45:31](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=2731)
- "Minimal mobilization technique for fundoplication reduced transmigration rate from 12% to 5%, and in recent prospective trial to zero" — Whit Holcomb (clinical) [Ep 1 · 57:23](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3443)
- "The primary reason for redo fundoplication is transmigration of the wrap into the chest" — Whit Holcomb (clinical) [Ep 1 · 57:00](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3420)
- "Surgeons need to do less rather than more dissection around the GE junction to prevent fundoplication failure" — Whit Holcomb (clinical) [Ep 1 · 59:22](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3562)
- "The fundoplication wrap must be done cephalad to the left gastric artery to ensure it's over the lower esophagus, not the stomach" — Whit Holcomb (clinical) [Ep 1 · 60:49](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3649)
- "Blenderized feeds through gastrostomy tubes have reduced rates of needing fundoplication because the heavy food migrates to the antrum away from the LES" — Rachel Rosen (clinical) [Ep 1 · 52:39](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3159)
- "Post-fundoplication patients should be imaged both by putting barium through the G-tube and from above via nasoesophageal tube to assess esophageal emptying" — Rachel Rosen (clinical) [Ep 1 · 62:02](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3722)
- "Blenderized feeds are effective therapy for treatment of post-fundoplication wretching" — Rachel Rosen (clinical) [Ep 1 · 63:07](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3787)
- "Using an esophageal bougie at the time of fundoplication prevents postoperative dysphagia and need for dilation" — Whit Holcomb (clinical) [Ep 1 · 63:40](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3820)
- "Pyloric Botox helps not only with delayed gastric emptying but also with the sensory component that triggers wretching" — Rachel Rosen (clinical) [Ep 1 · 54:19](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3259)
- "Cyproheptadine (Periactin) helps with gastric accommodation and controlling wretching in children" — Rachel Rosen (clinical) [Ep 1 · 54:26](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3266)
- "Botox doesn't reliably improve gastric emptying but helps significantly with wretching, suggesting a sensory mechanism" — Rachel Rosen (clinical) [Ep 1 · 68:18](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=4098)
- "Kids who wretch preoperatively are the most miserable post-fundoplication and should not be sent for surgery" — Rachel Rosen (clinical) [Ep 1 · 35:28](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=2128)
- "Rates of reflux post-fundoplication are between 10 and 20 reflux episodes per 24 hour period, which is considered acceptable" — Rachel Rosen (clinical) [Ep 1 · 71:39](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=4299)
- "Rumination syndrome patients describe vomiting 50-100 times a day, typically within minutes of starting a meal or the hour after, and should not undergo fundoplication" — Rachel Rosen (clinical) [Ep 1 · 78:43](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=4723)
- "Rumination can be diagnosed with a 30-minute esophageal motility study showing simultaneous gastric contraction with bolus movement up into the esophagus" — Rachel Rosen (clinical) [Ep 1 · 77:53](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=4673)
- "Kids who aspirate during swallowing and then get a fundoplication tend to do worse because saliva pools in the esophagus over the wrap" — Rachel Rosen (clinical) [Ep 1 · 49:02](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=2942)
- "Neurologically impaired children in the United States tend to have less severe impairment than those seen internationally because they enter healthcare earlier" — Whit Holcomb (epidemiological) [Ep 1 · 51:25](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3085)
- "A gap of two vertebral bodies or 2 centimeters is the threshold distance where primary anastomosis becomes feasible after growth in long-gap esophageal atresia" — Dan (guideline) [Ep 2 · 5:42](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=342)
- "Bougienage does not effectively reduce gap length in long-gap esophageal atresia" — Dan (opinion) [Ep 2 · 4:05](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=245)
- "Segmental colonic interposition preserves the distal esophagus and reduces risk of tortuosity compared to full-length interposition" — Dan (clinical) [Ep 2 · 9:00](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=540)
- "Pressure necrosis is the likely cause of mortality in experimental endoscopic Foker technique using olive beads in pigs" — Todd (clinical) [Ep 2 · 6:45](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=405)
- "Weekly dilation is more effective than longer intervals for recalcitrant esophageal strictures" — Todd (clinical) [Ep 2 · 40:46](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=2446)
- "Radial balloon dilation is superior to bougie dilators for esophageal strictures" — Todd (opinion) [Ep 2 · 41:47](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=2507)
- "Needle knife stricturotomy is effective for short, well-defined, asymmetric scar bands but not for long circumferential strictures" — Phil (clinical) [Ep 2 · 56:49](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=3409)
- "Patients born with tracheoesophageal fistulas, especially with VACTERL association, are at higher risk for eosinophilic esophagitis" — Phil (epidemiological) [Ep 2 · 46:03](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=2763)
- "Elemental formula is 95% effective for managing eosinophilic esophagitis in tube-fed infants" — Phil (clinical) [Ep 2 · 47:14](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=2834)
- "Esophageal stents can compress the adjacent trachea in children with tracheomalacia when the esophagus lies immediately posterior to the trachea" — Bob (clinical) [Ep 2 · 48:58](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=2938)
- "CT scan can predict risk of tracheal compression from esophageal distention by showing whether the esophagus lies posterior to the trachea or to the left" — Bob (clinical) [Ep 2 · 48:58](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=2938)
- "Chronic esophageal foreign bodies (pennies) can present as asthma due to posterior tracheal compression and may be missed for 6 weeks" — Mike (clinical) [Ep 2 · 50:20](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=3020)
- "Sometimes surgeons try too hard to salvage the native esophagus, leading to chronic aspiration and pulmonary disease that threatens life" — Dan (opinion) [Ep 2 · 44:54](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=2694)
- "Treating reflux with fundoplication before addressing recalcitrant strictures may improve stricture outcomes" — Dan (clinical) [Ep 2 · 43:07](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=2587)
- "Medical acid suppression alone cannot stop reflux without a mechanical barrier and may not prevent stricture recurrence" — Phil (clinical) [Ep 2 · 44:13](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=2653)
- "When mobilizing esophagus for anastomosis, the segments retract and become much shorter than they appear under tension" — Dan (clinical) [Ep 2 · 46:13](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=2773)
- "Median sternotomy provides excellent access for addressing high cervical esophageal strictures in patients with prior substernal interposition" — Dan (clinical) [Ep 2 · 20:09](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=1209)
- "Removing the manubrium for cervical esophageal access is less effective than anticipated because the clavicles limit the working space" — Mike (clinical) [Ep 2 · 16:38](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=998)
- "Magnets placed at stricture ends can create anastomosis by pressure necrosis (magnamosis), but the resulting connection lacks mucosal lining" — Todd (clinical) [Ep 2 · 30:25](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=1825)
- "Colon interposition can be anastomosed directly to the pharynx when no proximal esophagus remains" — Dan (clinical) [Ep 2 · 75:44](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=4544)
- "Patients who cannot swallow for years may continue spitting behavior even after successful esophageal reconstruction due to learned behavior" — Dan (clinical) [Ep 2 · 88:50](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=5330)
- "Leaving a native esophagus with tracheoesophageal fistulas in place while bypassing with colonic interposition can be a viable strategy when resection would destroy the posterior tracheal wall" — Dan (clinical) [Ep 2 · 86:54](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=5214)
- "A small tracheoesophageal fistula can serve as a drainage route for secretions from a bypassed esophageal segment, preventing mucocele formation" — Bob (clinical) [Ep 2 · 88:05](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=5285)
- "Bovine pericardium can be used for posterior tracheal reconstruction but carries risk of catastrophic failure with large defects" — Mike (clinical) [Ep 2 · 94:19](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=5659)
- "Tissue-engineered tracheal replacement using pre-epithelialized homografts is under development but not yet ready for routine clinical use" — Mike (clinical) [Ep 2 · 91:28](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=5488)
- "Combined simultaneous surgical approach with neck and abdominal teams working together can reduce operative time by several hours in complex esophageal cases" — Dan (clinical) [Ep 2 · 64:53](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=3893)
- "Flexible bronchoscopy should be performed after esophageal stent placement to assess for tracheal compression" — Mike (guideline) [Ep 2 · 48:28](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=2908)
- "When performing spit fistula, the distal esophagus must be mobilized all the way to the diaphragm and separated from the trachea to prevent recurrent fistulization" — Todd (clinical) [Ep 2 · 74:05](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=4445)
- "Scopes from above and below can be used simultaneously to identify stricture location during thoracoscopic resection by visualizing the light" — Todd (clinical) [Ep 2 · 26:28](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=1588)
- "Fused ribs from multiple thoracotomies can be separated by chipping away at them to gain adequate exposure" — Dan (clinical) [Ep 2 · 29:25](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-the-unsalvageable-esophagus-cases-738?t=1765)
- "Most children who aspirate have a functional or neurological problem rather than anatomical" — Michael Rutter (clinical) [Ep 3 · 4:39](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=279)
- "Lipid-laden macrophages are non-specific markers of aspiration and their recovery depends on material aspirated, amount, lipid content, and time since aspiration" — Bob Wood (clinical) [Ep 3 · 8:05](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=485)
- "Multi-channel intraluminal impedance testing detects reflux but does not diagnose aspiration itself" — Phil Putnam (clinical) [Ep 3 · 9:38](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=578)
- "If anti-reflux procedure is performed when patient is aspirating from above, it does not help and makes them worse" — Daniel von Allmen (clinical) [Ep 3 · 9:58](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=598)
- "Bugbee cautery is 3 French and serves as a smooth probe for finding small TEFs" — Michael Rutter (clinical) [Ep 3 · 12:10](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=730)
- "Cincinnati routinely performs bronchoscopy on all esophageal atresia cases" — Daniel von Allmen (clinical) [Ep 3 · 14:02](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=842)
- "Dual scoping allows visualization of light through tissue, injection of material through holes, and direct visualization of the other scope" — Phil Putnam (clinical) [Ep 3 · 20:22](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=1222)
- "Typical infant gastroscope is 5.4 or 6 millimeters outer diameter and fits retrograde through 16 French gastrostomy tube" — Phil Putnam (clinical) [Ep 3 · 21:12](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=1272)
- "Endoscopic TEF repair requires demucosalization of the tract because mucosa is a non-stick surface; need raw against raw for healing" — Michael Rutter (clinical) [Ep 3 · 23:41](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=1421)
- "Complete metadata for medical education content requires title, description, AI-generated summary, extracted and curated keywords, duration, content type, specialty area, target audience level, and language" — Michael Rutter (clinical) [Ep 3 · 24:50](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=1490)
- "Long skinny proximal-to-distal TEF tracts are ideal candidates for endoscopic repair; short fat wide tracts do not do well endoscopically" — Michael Rutter (clinical) [Ep 3 · 76:42](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=4602)
- "When repairing high TEF from thoracic approach, ligating fistula on esophageal side can leave large tracheal pouch/diverticulum" — Michael Rutter (clinical) [Ep 3 · 77:27](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=4647)
- "Endoscopic TEF closure success rate is approximately 80%, typically requiring 2 procedures" — Michael Rutter (clinical) [Ep 3 · 37:01](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=2221)
- "After 3-4 failed endoscopic TEF repair attempts, should consider open surgical approach" — Michael Rutter (clinical) [Ep 3 · 37:11](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=2231)
- "Button batteries can continue causing tissue damage for surprisingly long time, up to 6 weeks or more after removal" — Michael Rutter (clinical) [Ep 3 · 52:28](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=3148)
- "Dead button batteries still have approximately 2 volts and continue to cause injury" — Todd (clinical) [Ep 3 · 58:15](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=3495)
- "Button batteries can be distinguished from coins on AP X-ray by visible rim" — Todd (clinical) [Ep 3 · 58:20](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=3500)
- "Institutional protocol is to remove esophageal button batteries within 2 hours of identification as medical emergency" — Phil Putnam (guideline) [Ep 3 · 57:00](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=3420)
- "Large round flat 3-volt button batteries are most potentially damaging; smaller fatter batteries pose lower risk" — Michael Rutter (clinical) [Ep 3 · 60:54](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=3654)
- "Gastric button batteries are removed endoscopically before reaching duodenum to prevent gastric outlet stenosis" — Phil Putnam (clinical) [Ep 3 · 62:06](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=3726)
- "Transtracheal TEF repair is two-dimensional operation with less surgeon-dependency than three-dimensional operations like slide tracheoplasty" — Michael Rutter (opinion) [Ep 3 · 69:18](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=4158)
- "Slide tracheoplasty appears to have learning curve and is surgeon-dependent operation" — Michael Rutter (clinical) [Ep 3 · 70:10](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=4210)
- "For transtracheal repair, knots should be placed in lumen of trachea and esophagus rather than between layers to prevent refistulization" — Michael Rutter (clinical) [Ep 3 · 67:03](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=4023)
- "Sternal periosteum is like Kevlar, very strong and resilient, ideal for interposition grafts" — Michael Rutter (clinical) [Ep 3 · 47:05](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=2825)
- "When cauterizing in airway, oxygen concentration should be kept under 30% to reduce fire risk" — Michael Rutter (clinical) [Ep 3 · 38:35](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=2315)
- "Flexible bronchoscope is not reliable tool for diagnosing laryngeal cleft; cannot find them 95% of time even when known to be present" — Bob Wood (clinical) [Ep 3 · 116:37](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=6997)
- "Rigid bronchoscopy with probing is required for posterior commissure, subglottic space, or cervical trachea evaluation" — Bob Wood (clinical) [Ep 3 · 116:46](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=7006)
- "Tracheal pouches can be marsupialized using laparoscopic Storz click-line biopsy forceps at 40 watts cautery" — Michael Rutter (clinical) [Ep 3 · 118:01](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=7081)
- "2.8mm flexible bronchoscope with 1.2mm suction channel can accommodate 3 French bugbee cautery" — Bob Wood (clinical) [Ep 3 · 28:03](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=1683)
- "Retrograde esophagoscopy through G-tube provides easier maneuvering just below esophageal inlet for finding high fistulas" — Phil Putnam (clinical) [Ep 3 · 17:42](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=1062)
- "Multiple scopes provide different information and advantages in visualizing complicated aerodigestive patients" — Bob (opinion) [Ep 5 · 0:00](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-dual-endoscopy-discussion-1038?t=0)
- "Dual endoscopy is easier in patients with a tracheostomy but can be performed even without one" — Phil (clinical) [Ep 5 · 0:31](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-dual-endoscopy-discussion-1038?t=31)
- "Typical dual-scope setup uses a flexible scope through the nose and another through the mouth or retrograde through a G-tube into the esophagus" — Bob (clinical) [Ep 5 · 0:38](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-dual-endoscopy-discussion-1038?t=38)
- "Light from one scope can be visualized through the epithelium/wall by the other scope" (clinical) [Ep 5 · 0:54](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-dual-endoscopy-discussion-1038?t=54)
- "Injected material (saline or air bubbles) can be seen passing through subtle holes during dual endoscopy" (clinical) [Ep 5 · 0:54](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-dual-endoscopy-discussion-1038?t=54)
- "One operator can turn off their light to allow the other to see transillumination and confirm anatomic location" — Phil (clinical) [Ep 5 · 1:14](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-dual-endoscopy-discussion-1038?t=74)
- "A 2.8 mm flexible bronchoscope is typically used for airway visualization in dual endoscopy" (clinical) [Ep 5 · 1:34](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-dual-endoscopy-discussion-1038?t=94)
- "Infant gastroscopes used in small children are 5.4 or 6 mm outer diameter" (clinical) [Ep 5 · 1:34](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-dual-endoscopy-discussion-1038?t=94)
- "An infant scope will fit retrograde through a 16 French gastrostomy tube" (clinical) [Ep 5 · 1:52](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-dual-endoscopy-discussion-1038?t=112)
- "A 14 French G-tube is not large enough for retrograde infant scope passage without dilation" — Bob (clinical) [Ep 5 · 2:01](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-dual-endoscopy-discussion-1038?t=121)
- "Gastrostomy tubes can be dilated intraoperatively with Hagar dilators and will return to original size by case end" (clinical) [Ep 5 · 2:07](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-dual-endoscopy-discussion-1038?t=127)
- "A bronchoscope can occasionally be used for retrograde esophagoscopy when G-tube size is limiting" — Phil (clinical) [Ep 5 · 2:13](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-dual-endoscopy-discussion-1038?t=133)
- "The Aerodigestive Quad Conference will be held at Cincinnati Children's Hospital" (clinical) [Ep 11 · 0:00](https://library.globalcastmd.com/watch/quad-conference-commercial-5388?t=0)
- "Aerodigestive disease involves ENT, pediatric surgery, GI, pulmonary, and other specialties" (clinical) [Ep 11 · 0:12](https://library.globalcastmd.com/watch/quad-conference-commercial-5388?t=12)
- "Esophageal atresia and tracheoesophageal fistula management may require lifelong multidisciplinary care beyond surgery" (clinical) [Ep 11 · 0:26](https://library.globalcastmd.com/watch/quad-conference-commercial-5388?t=26)
- "The EAT (esophageal atresia) Global Support Groups will be involved with families attending both in person and virtually" (clinical) [Ep 11 · 0:43](https://library.globalcastmd.com/watch/quad-conference-commercial-5388?t=43)
- "The quad conference consists of 4 different conferences combined over 5 days" (clinical) [Ep 11 · 0:55](https://library.globalcastmd.com/watch/quad-conference-commercial-5388?t=55)
- "An airway dissection day and a flexible bronchoscopy day will follow the main conference" (clinical) [Ep 11 · 1:00](https://library.globalcastmd.com/watch/quad-conference-commercial-5388?t=60)
- "The conference dates are October 10th to 14th in Cincinnati" (clinical) [Ep 11 · 1:11](https://library.globalcastmd.com/watch/quad-conference-commercial-5388?t=71)
- "Cincinnati Children's typically uses a combined cervical and thoracic approach for esophageal atresia cases" — Alessandro de Alarcon (clinical) [Ep 16 · 0:49](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=49)
- "Preoperative testing includes dynamic CT imaging, pulmonary function tests, microlaryngoscopy and bronchoscopy, and flexible bronchoscopy" — Todd Ponsky (clinical) [Ep 16 · 0:55](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=55)
- "Intraoperative tools needed include a neck tray, MLB tray, and Maloney dilators versus NG tubes" — Alessandro de Alarcon (clinical) [Ep 16 · 1:15](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=75)
- "Flexible bronchoscopy during the operation is key for visualization" — Alessandro de Alarcon (clinical) [Ep 16 · 1:21](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=81)
- "Endotracheal tubes are often placed nasotracheally with the cuff positioned high, sometimes almost at the glottis" — Alessandro de Alarcon (clinical) [Ep 16 · 1:29](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=89)
- "A NIM tube is used when possible to prevent potential injury to recurrent nerves or provide awareness when getting close to them" — Alessandro de Alarcon (clinical) [Ep 16 · 1:39](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=99)
- "The surgical approach uses standard neck incision with subplatysmal flaps raised" — Alessandro de Alarcon (clinical) [Ep 16 · 1:55](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=115)
- "Residual or regrown large thymus can be removed during the cervical approach as it is in the way" — Todd Ponsky (clinical) [Ep 16 · 2:01](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=121)
- "Aortopexy and innominate artery pexy can be added at the same time as the cervical approach" — Alessandro de Alarcon (clinical) [Ep 16 · 2:09](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=129)
- "In the lateral approach, surgeons work on the side of the airway to find the esophagus" — Todd Ponsky (clinical) [Ep 16 · 2:19](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=139)
- "Pediatric surgeons find the recurrent nerve for the ENT team to help prevent injury" — Todd Ponsky (clinical) [Ep 16 · 2:23](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=143)
- "The esophagus is mobilized above the level where the team aims to pexy" — Todd Ponsky (clinical) [Ep 16 · 2:43](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=163)
- "Mobilizing the esophagus above the pexy level makes it easier to place sutures exactly where needed" — Todd Ponsky (clinical) [Ep 16 · 2:49](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=169)
- "Stitches are sometimes placed in the trachea to pull it up and out of the way to visualize the posterior aspect where the spine is visible" — Alessandro de Alarcon (clinical) [Ep 16 · 2:54](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=174)
- "A pulmonologist assists with visualization inside the trachea using flexible endoscopy through the endotracheal tube while stitches are being placed" — Todd Ponsky (clinical) [Ep 16 · 3:02](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=182)
- "3-0 Prolene sutures are used for the tracheopexy" — Alessandro de Alarcon (clinical) [Ep 16 · 3:15](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=195)
- "All stitches are placed before securing them down, and this is done under spontaneous ventilation conditions" — Alessandro de Alarcon (clinical) [Ep 16 · 3:15](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=195)
- "The combined approach is valuable for complicated cases or patients needing additional operations for symptom relief" — Todd Ponsky (opinion) [Ep 16 · 3:24](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=204)
- "Outcome measures include endoscopy follow-up, potentially PFTs when patients are old enough to perform them, and imaging" — Alessandro de Alarcon (clinical) [Ep 16 · 4:00](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=240)
- "At 36 months follow-up, imaging may still show some tracheomalacia even when patients are symptomatically better" — Alessandro de Alarcon (clinical) [Ep 16 · 4:09](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=249)
- "The field is still trying to learn exactly what measures should be used to define good versus bad outcomes" — Alessandro de Alarcon (opinion) [Ep 16 · 4:15](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=255)
- "Potential complications include swallowing dysfunction and vocal fold paralysis" — Alessandro de Alarcon (clinical) [Ep 16 · 4:26](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=266)
- "Otolaryngology involvement is important both in the procedure and during follow-up, and is easier when already built into the team" — Todd Ponsky (opinion) [Ep 16 · 4:32](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=272)
- "Birth history and patient size are important preoperative considerations" — Nathan Tighe (clinical) [Ep 20 · 0:53](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=53)
- "Physiologic status from ventilation and cardiac standpoints is particularly important in preoperative assessment" — Nathan Tighe (clinical) [Ep 20 · 0:57](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=57)
- "Esophageal atresia has an association with cardiac abnormalities" — Em Gootee (epidemiological) [Ep 20 · 1:05](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=65)
- "Preoperative airway assessment can reduce operating room time with the child under anesthesia" — Nathan Tighe (clinical) [Ep 20 · 1:13](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=73)
- "There are four anesthetic goals in the operating room: amnesia, akinesis, analgesia, and autonomic/hemodynamic stability" — Em Gootee (clinical) [Ep 20 · 1:24](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=84)
- "Akinesis (keeping kids still) is challenging in small children, especially when intraoperative neuromonitoring is involved" — Nathan Tighe (clinical) [Ep 20 · 1:33](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=93)
- "Short-acting opioid infusions are the most common technique for maintaining stillness and result in relatively little hemodynamic instability" — Em Gootee (clinical) [Ep 20 · 1:42](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=102)
- "Volatile anesthetics are especially useful when preservation of spontaneous ventilation is desired" — Em Gootee (clinical) [Ep 20 · 1:53](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=113)
- "Intraoperative neuromonitoring precludes the use of neuromuscular blocking drugs like rocuronium and vecuronium" — Nathan Tighe (clinical) [Ep 20 · 2:25](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=145)
- "Insufflation using pneumothorax can facilitate surgical exposure by overcoming peak inspiratory pressures to allow lung collapse" — Nathan Tighe (clinical) [Ep 20 · 2:31](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=151)
- "Insufflation is useful for small kids with good lung compliance but not effective in kids with severe bronchopulmonary dysplasia or other compliance abnormalities" — Em Gootee (clinical) [Ep 20 · 2:48](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=168)
- "Patients with compliance abnormalities require higher peak inspiratory pressures or mean airway pressures, which can necessitate very high insufflation pressures" — Nathan Tighe (clinical) [Ep 20 · 3:00](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=180)
- "Lung isolation utility is restricted by patient size and airway anatomy and requires expertise and specialized equipment" — Nathan Tighe (clinical) [Ep 20 · 3:20](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=200)
- "Three critical airway dimensions for lung isolation are tracheal AP diameter, bronchial diameters, and length of right mainstem bronchus between carina and right upper lobe takeoff" — Nathan Tighe (clinical) [Ep 20 · 3:34](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=214)
- "Regular endotracheal tube is the most common device for lung isolation in neonates because it is straightforward to mainstem" — Nathan Tighe (clinical) [Ep 20 · 4:05](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=245)
- "For esophageal atresia repairs, the endotracheal tube is typically mainstemmed into the left bronchus which has a good landing zone for the balloon" — Nathan Tighe (clinical) [Ep 20 · 4:11](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=251)
- "Bronchial blockers or Fogarty catheters require adequate space between the carina and right upper lobe takeoff for balloon placement" — Nathan Tighe (clinical) [Ep 20 · 4:28](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=268)
- "In kids with pig bronchus, bronchial blocker placement becomes very difficult and may require selective lobar blockade" — Em Gootee (clinical) [Ep 20 · 4:39](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=279)
- "A tracheal bronchus (pig bronchus) is an anatomical variant where an accessory bronchus originates directly from the supracarinal trachea" — Em Gootee (clinical) [Ep 20 · 4:48](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=288)
- "Bronchial blockers can be helpful in kids with abnormal parenchyma when higher ventilatory pressures are needed without using higher insufflation pressures" — Nathan Tighe (clinical) [Ep 20 · 5:07](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=307)
- "Double-lumen tubes can be used in larger kids (usually 8 years old or above) with recurrent fistulas and are the easiest device for lung isolation" — Em Gootee (clinical) [Ep 20 · 5:17](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=317)
- "Early conversations between anesthesiologists and surgeons about patient specifics are part of deciding the best modality for each individual patient" — Em Gootee (opinion) [Ep 20 · 5:38](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=338)
- "Unrepaired single ventricle kids are sensitive to changes in ventilation because they can have swings in circulation direction based on pulmonary vascular resistance" — Nathan Tighe (clinical) [Ep 20 · 5:55](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=355)
- "Single ventricle patients may be candidates for open surgery or ECMO support to ensure good outcomes" — Em Gootee (clinical) [Ep 20 · 6:07](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=367)
- "Insufflation causes changes in preload, making preload-sensitive patients (particularly those with passive pulmonary circulations) quite sensitive to this intervention" — Nathan Tighe (clinical) [Ep 20 · 6:18](https://library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=378)
- "Etiologies of pharyngeal stenosis include caustic ingestion, iatrogenic injury, or multi-level upper airway surgery" — Em Gootee (clinical) [Ep 21 · 0:42](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=42)
- "Pharyngeal stenosis from caustic ingestion requires management of physical obstruction, altered sensation, and altered motor function" — Douglas von Allmen (clinical) [Ep 21 · 0:52](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=52)
- "Treatment goals are tiered: adequate voice, breathing without tracheostomy, prevention of aspiration, and swallowing without G-tube" — Em Gootee (clinical) [Ep 21 · 1:05](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=65)
- "The presented patient had drooling, difficulty managing secretions, and significant airway compromise requiring urgent tracheostomy" — Douglas von Allmen (clinical) [Ep 21 · 1:30](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=90)
- "Initial bronchoscopy one month post-tracheostomy showed extensive hypopharyngeal scarring with no discernible esophageal inlet or laryngeal structures" — Douglas von Allmen (clinical) [Ep 21 · 1:43](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=103)
- "The base of the tongue was scarred to the hypopharyngeal wall" — Douglas von Allmen (clinical) [Ep 21 · 1:55](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=115)
- "After scar tissue removal, the large raw surface area poses a risk of re-scarring" — Douglas von Allmen (clinical) [Ep 21 · 2:10](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=130)
- "Free mucosal grafts can be used to prevent re-scarring" — Douglas von Allmen (clinical) [Ep 21 · 2:19](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=139)
- "A modified suprastomal stent placed through the glottis and wrapped with silastic sheeting increases the effective diameter" — Douglas von Allmen (clinical) [Ep 21 · 2:22](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=142)
- "Prolonged stenting of 4 to 6 weeks is typical for pharyngeal stenosis management" — Em Gootee (clinical) [Ep 21 · 2:59](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=179)
- "Patients with caustic injuries may tolerate suprastomal stents better than airway reconstruction patients due to disrupted sensation in the hypopharynx and oropharynx" — Douglas von Allmen (clinical) [Ep 21 · 3:09](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=189)
- "At 4-6 weeks post-stent placement, well-healed mucosa and improved glottic inlet access were observed" — Em Gootee (clinical) [Ep 21 · 3:28](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=208)
- "At one-year follow-up, the patient remained tracheostomy and G-tube dependent despite colon interposition" — Em Gootee (clinical) [Ep 21 · 3:50](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=230)
- "The patient achieved ability to take PO tastes and improved secretion management after colon interposition" — Douglas von Allmen (clinical) [Ep 21 · 3:53](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=233)
- "Balloon dilation works mostly in the post-cricoid area for smaller circumferential stenosis" — Douglas von Allmen (clinical) [Ep 21 · 4:10](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=250)
- "Larger caliber balloons are needed to dilate stenosis in the oropharynx and hypopharynx" — Douglas von Allmen (clinical) [Ep 21 · 4:15](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=255)
- "Adjuvant injectables such as steroids, mitomycin C, and 5-fluorouracil can delay recalcitrant scar formation" — Em Gootee (clinical) [Ep 21 · 4:24](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=264)
- "Rotational flaps and free flaps can be used to break up scarring" — Douglas von Allmen (clinical) [Ep 21 · 4:46](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=286)
- "Z-plasty technique can be used to break up scar orientation by rotating mucosal flaps" — Douglas von Allmen (clinical) [Ep 21 · 5:04](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=304)
- "Staged procedures are helpful to avoid creating circumferential scarring" — Douglas von Allmen (clinical) [Ep 21 · 5:13](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=313)
- "Many pharyngeal stenosis patients require tracheostomy due to extensive supraglottic scarring" — Douglas von Allmen (clinical) [Ep 21 · 5:40](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=340)
- "Pharyngeal stenosis patients are at high risk for ongoing aspiration" — Em Gootee (clinical) [Ep 21 · 5:48](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=348)
- "Tracheostomy can be helpful for managing aspiration risk in pharyngeal stenosis patients" — Em Gootee (clinical) [Ep 21 · 5:48](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=348)
- "Swallowing outcomes can be difficult and poor in the long term for pharyngeal stenosis patients" — Em Gootee (clinical) [Ep 21 · 5:55](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=355)
- "Involvement of speech language pathologists and pulmonary colleagues is important for managing aspiration sequelae" — Douglas von Allmen (clinical) [Ep 21 · 6:03](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=363)
- "Pharyngeal stenosis patients warrant long-term surveillance" — Douglas von Allmen (clinical) [Ep 21 · 6:11](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=371)
- "There is suggestion that pharyngeal stenosis patients may be at increased risk for malignancy and surveillance for neoplasm development is helpful" — Douglas von Allmen (epidemiological) [Ep 21 · 6:15](https://library.globalcastmd.com/watch/quad-5-pharyngeal-scar-management-with-dr-doug-von-allmen-8116?t=375)
- "Chronic lung aspiration from tracheomalacia has long-term detrimental consequences" — Aaron Garrison (clinical) [Ep 17 · 0:58](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=58)
- "In the last 4 to 5 years, it has become standard practice to determine which patients will respond best to tracheopexy versus aortopexy" — Em Gootee (guideline) [Ep 17 · 0:43](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=43)
- "Dynamic reconstruction studies with inspiratory and expiratory films are necessary to evaluate patients for aortopexy" — Aaron Garrison (clinical) [Ep 17 · 1:26](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=86)
- "Preoperative workup must confirm there is space to anteriorly suspend the aorta to make the trachea diameter larger" — Em Gootee (clinical) [Ep 17 · 1:45](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=105)
- "The thymus must be evaluated to ensure there is enough tissue to remove to bring the trachea up anteriorly" — Aaron Garrison (clinical) [Ep 17 · 1:55](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=115)
- "Preoperative bronchoscopy assists in classifying the degree of tracheomalacia prior to surgical intervention" — Em Gootee (clinical) [Ep 17 · 2:02](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=122)
- "The classification system for tracheomalacia severity is in evolution and describing mild, moderate, or severe is challenging" — Aaron Garrison (opinion) [Ep 17 · 2:17](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=137)
- "The biggest benefit of minimally invasive approach is visualization and exposure" — Aaron Garrison (opinion) [Ep 17 · 2:34](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=154)
- "Disadvantages of minimally invasive approach include longer learning time, discomfort during learning, and anesthesia concerns about case duration" — Aaron Garrison (clinical) [Ep 17 · 2:39](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=159)
- "A study in Anesthesiology comparing open, thoracoscopic, and converted patients found no difference in blood gases and metabolic derangements during surgery" — Aaron Garrison (epidemiological) [Ep 17 · 3:03](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=183)
- "There is no difference in blood pressure, acidosis, or hypoxia between open and thoracoscopic approaches" — Aaron Garrison (epidemiological) [Ep 17 · 3:17](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=197)
- "Correct positioning is key to success in thoracoscopic approach, using gravity to aid in retracting lungs" — Em Gootee (clinical) [Ep 17 · 3:23](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=203)
- "The goal of aortopexy is to suspend the aorta by first removing the thymus, finding the innominate-aortic junction, and identifying the arch of the aorta" — Aaron Garrison (clinical) [Ep 17 · 3:51](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=231)
- "Finding the pericardial-adventitial junction to suspend is the key point in aortopexy" — Em Gootee (clinical) [Ep 17 · 4:01](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=241)
- "If sutures are placed too high during aortopexy, a pericardiopexy results which is not as successful or durable" — Aaron Garrison (clinical) [Ep 17 · 4:10](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=250)
- "Passing suture transternally is preferred in aortopexy though it can be technically difficult" — Em Gootee (clinical) [Ep 17 · 4:16](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=256)
- "For tracheopexy, a posterior approach via semiprone position is preferred" — Em Gootee (clinical) [Ep 17 · 4:23](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=263)
- "Creating a pneumothorax by placing the Veress off the tip of the scapula helps collapse the lung for trocar placement" — Em Gootee (clinical) [Ep 17 · 4:28](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=268)
- "Triangulating hands gives the best visualization and working space during posterior tracheopexy" — Em Gootee (clinical) [Ep 17 · 4:38](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=278)
- "The goal of posterior tracheopexy is fixing the anterior spinal ligament to the posterior membranous trachea distal to the dilated pouch" — Aaron Garrison (clinical) [Ep 17 · 4:45](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=285)
- "Multidisciplinary team with pulmonologist allows internal visualization via bronchoscopy, primarily used in non-esophageal atresia patients" — Em Gootee (clinical) [Ep 17 · 4:56](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=296)
- "An indent can be made on the posterior wall of the trachea that is visible on bronchoscopy to guide suture placement" — Aaron Garrison (clinical) [Ep 17 · 5:09](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=309)
- "It usually takes about 2 or 3 sutures for tracheopexy, leaving enough space for the esophagus to come through" — Aaron Garrison (clinical) [Ep 17 · 5:43](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=343)
- "Using a knot pusher and tension suture is helpful in tracheopexy" — Aaron Garrison (opinion) [Ep 17 · 5:48](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=348)
- "Getting the suture to roll through the anterior spinal ligament is the hardest part of the procedure" — Aaron Garrison (opinion) [Ep 17 · 5:58](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=358)
- "For patients without esophageal atresia or with esophagus in continuity, the first step is to dissect around the esophagus using a vessel loop for retraction" — Em Gootee (clinical) [Ep 17 · 6:07](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=367)
- "The esophagus can be placed to either the left or right of the trachea during tracheopexy" — Aaron Garrison (clinical) [Ep 17 · 6:20](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=380)
- "Dysphagia after esophageal repositioning is a concern but has not been seen frequently" — Aaron Garrison (opinion) [Ep 17 · 6:26](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=386)
- "Pre and post-operative bronchoscopy allows visualization of improvement in posterior tracheal intrusion prior to case completion" — Em Gootee (clinical) [Ep 17 · 6:32](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=392)
- "A 1992 study of over 2000 button battery ingestions found no deaths" — Em Gootee (epidemiological) [Ep 18 · 0:41](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=41)
- "Recent studies show a sevenfold increase in fatalities following button battery ingestions" — Em Gootee (epidemiological) [Ep 18 · 0:52](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=52)
- "The increase in fatalities is due to change to 20-volt lithium cells which cause coagulative necrosis" — Em Gootee (clinical) [Ep 18 · 0:59](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=59)
- "There are 3 locations in the esophagus where foreign bodies tend to get stuck: upper esophageal sphincter, behind the aortic arch, and at the lower esophageal sphincter" — Aaron Garrison (clinical) [Ep 18 · 1:06](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=66)
- "Button batteries cause transmural injury and create fistulas to adjacent structures including trachea and blood vessels" — Em Gootee (clinical) [Ep 18 · 1:14](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=74)
- "High-risk criteria include younger patients with smaller esophagus" — Aaron Garrison (clinical) [Ep 18 · 1:33](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=93)
- "Batteries 20 millimeters or greater in size are riskier" — Em Gootee (clinical) [Ep 18 · 1:39](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=99)
- "Longer duration of battery dwell time increases risk" — Aaron Garrison (clinical) [Ep 18 · 1:43](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=103)
- "Battery location behind the aortic arch is more concerning" — Em Gootee (clinical) [Ep 18 · 1:49](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=109)
- "Patients who present with bleeding after battery removal require emergency management" — Aaron Garrison (clinical) [Ep 18 · 1:52](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=112)
- "In a Colorado study of 13 high-severity injury patients, 30% had esophageal perforation" — Em Gootee (epidemiological) [Ep 18 · 2:05](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=125)
- "23% of high-severity injury patients developed strictures" — Em Gootee (epidemiological) [Ep 18 · 2:14](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=134)
- "High-severity injury patients stayed in hospital for nearly 2 weeks" — Em Gootee (epidemiological) [Ep 18 · 2:16](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=136)
- "Almost 25% of patients in the Colorado series died" — Aaron Garrison (epidemiological) [Ep 18 · 2:22](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=142)
- "Two fatalities in the series presented with batteries already in the stomach" — Aaron Garrison (epidemiological) [Ep 18 · 2:22](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=142)
- "Sentinel bleeds can be the first sign of aortoenteric fistulas" — Em Gootee (clinical) [Ep 18 · 2:32](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=152)
- "Some aortoesophageal fistulas appeared over 2 weeks after battery removal" — Em Gootee (clinical) [Ep 18 · 2:50](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=170)
- "Fistula formation does not always happen during hospitalization" — Aaron Garrison (clinical) [Ep 18 · 2:55](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=175)
- "Management should stratify patients as sick versus well-appearing" — Aaron Garrison (clinical) [Ep 18 · 3:09](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=189)
- "For esophageal foreign bodies with active bleeding or clinical instability, GI surgery and CT surgery should be available for the procedure" — Aaron Garrison (guideline) [Ep 18 · 3:26](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=206)
- "CTA imaging before endoscopy can assess inflammation and proximity to aorta" — Em Gootee (clinical) [Ep 18 · 3:39](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=219)
- "If imaging shows injury close to aorta, continue NPO and antibiotics and repeat MRI in 5-7 days to assess trajectory of inflammation" — Aaron Garrison (guideline) [Ep 18 · 3:47](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=227)
- "For high-risk patients (under 5 years, larger battery), endoscopic evaluation of esophagus is recommended even if battery reached the stomach" — Aaron Garrison (guideline) [Ep 18 · 4:30](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=270)
- "ECMO or cardiopulmonary bypass need depends on fistula location and ability to intubate past the injury to adequately ventilate" — Aaron Garrison (clinical) [Ep 18 · 4:43](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=283)
- "Fistulas near the carina require complex airway reconstruction and preclude adequate ventilation during repair" — Aaron Garrison (clinical) [Ep 18 · 4:59](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=299)
- "For esophageal perforation, standard approach is debridement to viable tissue, layered closure, and muscle flap coverage when possible" — Aaron Garrison (clinical) [Ep 18 · 6:56](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=416)
- "If perforation is too large, drain and plan delayed repair" — Aaron Garrison (clinical) [Ep 18 · 7:09](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=429)
- "Button batteries are ingested more than 3500 times per year in the United States" — Em Gootee (epidemiological) [Ep 18 · 6:10](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=370)
- "Caustic ingestion is most common in children between 1 and 3 years of age" — Em Gootee (epidemiological) [Ep 18 · 6:20](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=380)
- "Most caustic ingestions by children are accidental and amounts tend to be small" — Em Gootee (epidemiological) [Ep 18 · 6:25](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=385)
- "Airway management may take priority over the ingested substance in caustic injuries" — Aaron Garrison (clinical) [Ep 18 · 6:31](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=391)
- "Caustic ingestion patients can present with stridor or allergic-reaction-like symptoms, especially with acidic substances" — Aaron Garrison (clinical) [Ep 18 · 6:38](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=398)
- "Severe epiglottic injury can occur from caustic substances that are spit back up rather than swallowed" — Em Gootee (clinical) [Ep 18 · 6:43](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=403)
- "Injuries from button batteries can progress even after removal" — Em Gootee (clinical) [Ep 18 · 7:25](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=445)
- "Small perforations from caustic ingestion can heal and be managed conservatively" — Em Gootee (clinical) [Ep 18 · 7:39](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=459)
- "Strictures from caustic ingestion may require dilation or surgery" — Em Gootee (clinical) [Ep 18 · 7:43](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=463)
- "Slide tracheoplasty technique involves transecting the trachea above and below the fistula with a bevel to minimize tracheal length loss" — Michael Rutter (clinical) [Ep 19 · 1:25](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=85)
- "Part of the trachea is used to repair the esophagus in slide tracheoplasty" — Michael Rutter (clinical) [Ep 19 · 1:35](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=95)
- "Periosteum interposition grafts are often used in slide tracheoplasty repairs" — Michael Rutter (clinical) [Ep 19 · 1:35](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=95)
- "H-type TEF can be difficult to locate and requires tracheoscopy or esophagoscopy for identification" — Kim Pribben (clinical) [Ep 19 · 2:06](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=126)
- "The front wall of the esophagus becomes a piece of trachea in the slide tracheoplasty repair" — Michael Rutter (clinical) [Ep 19 · 2:18](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=138)
- "4-0 PDS suture is used in running suture technique for the repair" — Michael Rutter (clinical) [Ep 19 · 2:18](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=138)
- "Nerve hooks can be used to slowly bring together structures with large distances between trachea and esophagus by tightening multiple throws" — Michael Rutter (clinical) [Ep 19 · 2:47](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=167)
- "Serial esophagoscopies provide good assessment of surgical outcomes in challenging TEF cases" — Kim Pribben (clinical) [Ep 19 · 2:59](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=179)
- "Esophageal stent placement can stabilize patients with TEF and mediastinal communication, eliminating mediastinal communication even if not fixing the fistula" — Michael Rutter (clinical) [Ep 19 · 4:23](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=263)
- "Transternal, transtracheal approach provides excellent exposure to the esophagus for complex TEF repairs" — Michael Rutter (clinical) [Ep 19 · 4:50](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=290)
- "Tibial periosteum can be harvested as interposition graft material" — Michael Rutter (clinical) [Ep 19 · 4:55](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=295)
- "Periosteum is effective at protecting one lumen from another in TEF repairs" — Michael Rutter (clinical) [Ep 19 · 5:05](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=305)
- "Intraoperative pulmonologist assistance with tracheoscopy through the ET tube aids in fistula identification" — Kim Pribben (clinical) [Ep 19 · 5:12](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=312)
- "The slide tracheoplasty repair sequence includes tracheal and esophageal transection, slide esophagoplasty, interposition graft placement, and tracheal closure" — Kim Pribben (clinical) [Ep 19 · 5:42](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=342)
- "Slide tracheoplasty is not suitable for every TEF case but provides valuable options for challenging repairs" — Michael Rutter (opinion) [Ep 19 · 6:26](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=386)
- "Collaborative surgical teams including pulmonologists enhance surgical precision in complex TEF repairs" — Kim Pribben (opinion) [Ep 19 · 6:58](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=418)
- "Cincinnati Children's has one of the largest aerodigestive centers in the world" — Lizzie Lee (epidemiological) [Ep 25 · 0:47](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=47)
- "The clinical assessment is a poor predictor when there are airway protection issues" — Claire Miller (clinical) [Ep 25 · 2:44](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=164)
- "Patients with TEF have a lot of other things other than incompetent lower esophageal sphincters including motility problems, hernias, and delayed emptying" — Scott Pentik (clinical) [Ep 25 · 4:31](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=271)
- "Patients with eosinophilic esophagitis often have procedures performed on them even before their diagnosis" — Scott Pentik (clinical) [Ep 25 · 5:21](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=321)
- "There is an increase in airway surgery complications in patients who were later found to have eosinophilic esophagitis" — Lizzie Lee (clinical) [Ep 25 · 5:28](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=328)
- "The team now does endoscopy as part of workup prior to even considering surgery" — Scott Pentik (guideline) [Ep 25 · 5:35](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=335)
- "After TEF repairs, the esophagus doesn't squeeze, leading to more reflux, more dysphagia, and impactions" — Scott Pentik (clinical) [Ep 25 · 6:04](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=364)
- "76% of patients in the aerodigestive program had a feeding disorder" — Lizzie Lee (epidemiological) [Ep 25 · 6:13](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=373)
- "Tracheomalacia is a very common comorbidity in patients with history of esophageal fistula or atresia" — Sherry Torres Silva (clinical) [Ep 25 · 8:22](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=502)
- "High-resolution CT is the gold standard for diagnosis because it's highly sensitive and detects early changes of the small airways" — Sherry Torres Silva (guideline) [Ep 25 · 8:36](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=516)
- "Risk factors for chronic pulmonary aspiration include preemie babies, swallowing dysfunction, GI dysmotility, cardiothoracic esophageal and airway history" — Sherry Torres Silva (clinical) [Ep 25 · 7:32](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=452)
- "CHARGE syndrome, Mobius, Criducha, and trisomy syndromes should be considered aspirational until proven otherwise" — Sherry Torres Silva (clinical) [Ep 25 · 7:32](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=452)
- "Patients with airway obstruction, especially upper airway, will have symptoms with sleep and significant exertion or agitation" — Sherry Torres Silva (clinical) [Ep 25 · 8:02](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=482)
- "Noisy breathing might be one of the most significant symptoms reported in upper airway obstruction" — Sherry Torres Silva (clinical) [Ep 25 · 8:09](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=489)
- "The vision of the aerodigestive and esophageal Center is to improve efficiency and communication between team members and the family" — Claire Miller (opinion) [Ep 25 · 1:28](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=88)
- "The role of the speech pathologist is to evaluate dysphagia, voice, and communication issues" — Claire Miller (clinical) [Ep 25 · 2:29](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=149)
- "Video fluoroscopic swallowing study analyzes different phases of swallowing" — Lizzie Lee (clinical) [Ep 25 · 2:52](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=172)
- "FEES allows visualization of pharyngeal and laryngeal structures and assessment of function, aspiration, and residual after each swallow" — Lizzie Lee (clinical) [Ep 25 · 2:59](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=179)
- "High resolution pharyngeal manometry allows objective assessment of the pressures of the swallow to understand what is underlying a swallowing dysfunction" — Claire Miller (clinical) [Ep 25 · 3:13](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=193)
- "ENT helps stratify the risk of proceeding with airway reconstruction and decannulation based on swallowing study results" — Lizzie Lee (clinical) [Ep 25 · 3:48](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=228)
- "GERD pathophysiology includes an incompetent lower esophageal sphincter" — Lizzie Lee (clinical) [Ep 25 · 4:19](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=259)
- "General signs and symptoms of GERD include regurgitation, vomiting, and heartburn" — Lizzie Lee (clinical) [Ep 25 · 4:42](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=282)
- "Impedance is a tool used to measure reflux and distinguish between swallows and actual reflux events" — Scott Pentik (clinical) [Ep 25 · 4:48](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=288)
- "Kids will have Nissans and then have hernias later" — Scott Pentik (clinical) [Ep 25 · 5:49](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=349)
- "Pulmonologists use medical management of aspiration including control of sialorrhea, optimization of airway clearance, and use of anti-inflammatory medications for chronic aspiration or inflammation" — Sherry Torres Silva (clinical) [Ep 25 · 9:02](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=542)
- "The pulmonologist determines if the child still needs ventilatory support and whether they're ready for decannulation" — Lizzie Lee (clinical) [Ep 25 · 9:15](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=555)
- "The pulmonologist assesses how ready the patient is for weaning from the vent and whether they can start or advance feeding" — Lizzie Lee (clinical) [Ep 25 · 9:26](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=566)
- "Esophageal atresia patients often have tracheobronchomalacia" — Lizzie Lee (clinical) [Ep 26 · 0:13](https://library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435?t=13)
- "Tracheobronchomalacia can cause serious breathing problems like blue spells in esophageal atresia patients" — Lizzie Lee (clinical) [Ep 26 · 0:13](https://library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435?t=13)
- "The study reviewed 80 esophageal atresia patients who underwent tracheobronchopexy at two hospitals between 2013 and 2021" — Lizzie Lee (epidemiological) [Ep 26 · 0:23](https://library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435?t=23)
- "94% of esophageal atresia patients who underwent tracheobronchopexy were able to avoid tracheostomy" — Lizzie Lee (clinical) [Ep 26 · 0:33](https://library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435?t=33)
- "Tracheobronchopexy significantly reduced life-threatening breathing events in esophageal atresia patients" — Lizzie Lee (clinical) [Ep 26 · 0:38](https://library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435?t=38)
- "Tracheobronchopexy significantly reduced the need for positive pressure ventilation in esophageal atresia patients" — Lizzie Lee (clinical) [Ep 26 · 0:38](https://library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435?t=38)
- "Tracheobronchopexy significantly reduced ventilator dependence in esophageal atresia patients" — Lizzie Lee (clinical) [Ep 26 · 0:38](https://library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435?t=38)
- "80 patients with severe airway collapse after esophageal atresia repair represents a huge number; most pediatric surgeons won't see 10 such patients in their career" — George W. Holcomb III (epidemiological) [Ep 27 · 2:17](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=137)
- "90% of patients showed complete airway collapse on dynamic bronchoscopy" — George W. Holcomb III (clinical) [Ep 27 · 2:34](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=154)
- "Three-quarters of procedures used a posterior approach" — George W. Holcomb III (clinical) [Ep 27 · 2:40](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=160)
- "Tracheobronchopexy was performed on thoracic trachea alone in over half the patients, but had to be extended to bronchi in 40%" — George W. Holcomb III (clinical) [Ep 27 · 2:44](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=164)
- "94% of patients avoided tracheostomy with a mortality rate of 5%" — George W. Holcomb III (clinical) [Ep 27 · 2:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=177)
- "The procedure significantly reduced pressure ventilation and ventilator dependence" — George W. Holcomb III (clinical) [Ep 27 · 2:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=177)
- "Canada is the second largest country in the world geographically" — Eric Skarsgard (epidemiological) [Ep 27 · 5:28](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=328)
- "The majority of Canada's population lives within 200 kilometers of the US border" — Eric Skarsgard (epidemiological) [Ep 27 · 5:38](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=338)
- "Outreach services were present in only 7 out of 10 provinces" — Preet Bir (epidemiological) [Ep 27 · 6:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=403)
- "Only 8 out of 18 children's hospitals (44%) provided outreach services" — Preet Bir (epidemiological) [Ep 27 · 6:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=403)
- "A significant number of outreach services are located within 50 kilometers of a children's hospital" — Em Gootee (epidemiological) [Ep 27 · 6:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=417)
- "In most places in Canada, no one would transfer a 16 or 17 year old with appendicitis to a children's hospital for surgery" — Eric Skarsgard (clinical) [Ep 27 · 7:36](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=456)
- "The Canadian healthcare system does not ensure timely care; children wait for surgery beyond their wait time target" — Eric Skarsgard (opinion) [Ep 27 · 8:01](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=481)
- "Newfoundland and Labrador has the best outreach setup with two pediatric surgeons who have established outreach clinics all over the province" — Eric Skarsgard (clinical) [Ep 27 · 8:16](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=496)
- "In the NSQIP database, 5% of all pediatric procedures were G-tube placements" — Sean Kunisaki (epidemiological) [Ep 27 · 11:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=716)
- "The study analyzed 4,612 G-tube placements from 71 NSQIP-Pediatric hospitals in 2023" — Em Gootee (epidemiological) [Ep 27 · 12:38](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=758)
- "77% of G-tube cases were first-time placements as opposed to redos" — Anusha Maturu / Derek Wakeman (epidemiological) [Ep 27 · 12:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=766)
- "Upper GI studies were obtained in 45% of first-time G-tube cases with interhospital variability from 0 to 99%" — Em Gootee (clinical) [Ep 27 · 13:04](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=784)
- "14% of G-tube cases resulted in an ED visit within 0 to 30 days" — Em Gootee (clinical) [Ep 27 · 13:45](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=825)
- "5.2% of G-tube cases involved dislodgement within 0 to 30 days" — Em Gootee (clinical) [Ep 27 · 13:45](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=825)
- "An additional 5.5% of G-tubes were dislodged in the 31 to 60 day period" — Anusha Maturu / Derek Wakeman (clinical) [Ep 27 · 13:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=835)
- "If dislodgements can be reduced, ED visits go down correspondingly" — Anusha Maturu / Derek Wakeman (clinical) [Ep 27 · 14:15](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=855)
- "Most patients in the tracheobronchopexy series had type C esophageal atresia" — Em Gootee (clinical) [Ep 27 · 2:28](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=148)
- "Most children who aspirate have a functional or neurological problem" (clinical) [Ep 6 · 0:10](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=10)
- "Cerebral palsy and CHARGE syndrome are examples of functional/neurological causes of aspiration" (clinical) [Ep 6 · 0:16](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=16)
- "Anatomical problems causing aspiration include tracheoesophageal fistula and laryngeal cleft" (clinical) [Ep 6 · 0:22](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=22)
- "Bad pharyngeal scar can cause aspiration in some children" (clinical) [Ep 6 · 0:34](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=34)
- "Esophageal stenosis with backup and spillover can cause aspiration" (clinical) [Ep 6 · 0:39](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=39)
- "Nasogastric tube or gastrostomy tube can be considered for children who aspirate food and drink" (clinical) [Ep 6 · 0:53](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=53)
- "Robinul (glycopyrrolate) generally does not work for managing saliva aspiration" (opinion) [Ep 6 · 1:13](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=73)
- "Botox to major salivary glands is a temporary solution and a good test run for how a child would cope with less saliva" (clinical) [Ep 6 · 1:19](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=79)
- "Drool procedure involves removing submandibular glands and ligating parotid ducts" (clinical) [Ep 6 · 1:30](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=90)
- "Tracheotomy allows suctioning the airway clear of secretions" (clinical) [Ep 6 · 1:38](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=98)
- "BiPAP on a tracheostomy blows secretions up and out of the mouth" (clinical) [Ep 6 · 1:45](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=105)
- "Laryngotracheal separation is the only guaranteed operation to stop aspiration" (clinical) [Ep 6 · 1:53](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=113)
- "Laryngotracheal separation is not commonly done because you lose your ability to vocalize" (clinical) [Ep 6 · 2:02](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=122)
- "Nissen fundoplication or any sort of fundoplication may assist with gastroesophageal reflux aspiration" (clinical) [Ep 6 · 2:09](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=129)
- "GJ tube may assist with gastroesophageal reflux aspiration" (clinical) [Ep 6 · 2:09](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=129)
- "Tight fundoplication with non-motile esophagus can cause accumulation and spillover of esophageal contents" (clinical) [Ep 6 · 2:21](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=141)
- "In children with tracheostomy, putting colored dye in the mouth and checking if it comes out the trach tube is the simplest test for aspiration" — Bob (clinical) [Ep 6 · 2:55](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=175)
- "Dye test can be done at home in a normal setting and repeated" — Bob (clinical) [Ep 6 · 3:05](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=185)
- "Dye test is helpful to convince skeptical parents that the child is aspirating" — Bob (opinion) [Ep 6 · 3:10](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=190)
- "Video swallow studies and endoscopic swallow studies can be useful for testing aspiration" — Bob (clinical) [Ep 6 · 3:18](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=198)
- "There are no unequivocal endoscopic markers of aspiration" — Bob (clinical) [Ep 6 · 3:23](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=203)
- "Lipid-laden macrophages are non-specific markers of aspiration" — Bob (clinical) [Ep 6 · 3:35](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=215)
- "Recovery of lipid-laden macrophages depends on what material was aspirated, how much lipid it contained, the amount aspirated, and time since aspiration" — Bob (clinical) [Ep 6 · 3:35](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=215)
- "Lots of lipid-laden macrophages in the right clinical setting is convincing evidence of aspiration, but not a black and white yes/no answer" — Bob (opinion) [Ep 6 · 3:57](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=237)
- "Green food dye is preferred for dye testing because it is not a natural body color" (clinical) [Ep 6 · 4:24](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=264)
- "Nuclear medicine scan with radioactive tracer on tongue can detect saliva aspiration in patients without tracheostomy" (clinical) [Ep 6 · 4:35](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=275)
- "No reflux testing methods are particularly good markers for aspiration" — Phil (opinion) [Ep 6 · 5:02](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=302)
- "Multi-channel intraluminal impedance testing has mostly replaced simple pH testing for detection of reflux" — Phil (clinical) [Ep 6 · 5:08](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=308)
- "Impedance testing does not add anything to the diagnosis of aspiration itself" — Phil (clinical) [Ep 6 · 5:08](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=308)
- "Impedance testing tells you whether something is being delivered from the stomach to the esophagus, but not what happens to it after that" — Phil (clinical) [Ep 6 · 5:21](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=321)
- "The Pediatric Surgical Oncology Research Collaborative study reviewed practices at 15 hospitals for localizing small pulmonary nodules in children" — Ellen Encisco (clinical) [Ep 14 · 0:24](https://library.globalcastmd.com/watch/quick-literature-updates-episode-8-6713?t=24)
- "Different institutions use various localization methods including wires, methylene blue dye, indocyanine green, micro coils, and technetium 99 in different combinations" — Ellen Encisco (clinical) [Ep 14 · 0:24](https://library.globalcastmd.com/watch/quick-literature-updates-episode-8-6713?t=24)
- "There was no significant difference in the success of localization between all of the different techniques for pulmonary nodules" — Ellen Encisco (clinical) [Ep 14 · 0:24](https://library.globalcastmd.com/watch/quick-literature-updates-episode-8-6713?t=24)
- "The only significant differences in pulmonary nodule localization were in which institution performed each technique, and in IR, OR, and anesthesia times" — Ellen Encisco (clinical) [Ep 14 · 0:24](https://library.globalcastmd.com/watch/quick-literature-updates-episode-8-6713?t=24)
- "In the Nuss repair study, approximately 40 pediatric patients received a Nuss bar repair for pectus excavatum with perioperative ERAS pain protocol" — Rod Gerardo (clinical) [Ep 14 · 1:31](https://library.globalcastmd.com/watch/quick-literature-updates-episode-8-6713?t=91)
- "92% of patients who received Nuss bar repair were discharged on post-operative day one" — Rod Gerardo (clinical) [Ep 14 · 1:31](https://library.globalcastmd.com/watch/quick-literature-updates-episode-8-6713?t=91)
- "There was a reduction in the total number of morphine equivalent doses that Nuss repair patients received without any difference in their pain scores at the time of discharge" — Rod Gerardo (clinical) [Ep 14 · 1:31](https://library.globalcastmd.com/watch/quick-literature-updates-episode-8-6713?t=91)
- "The transamniotic stem cell therapy study was a pre-clinical study made by Boston Children's Hospital and Harvard Medical School" — Cecilia Gigena (clinical) [Ep 14 · 2:33](https://library.globalcastmd.com/watch/quick-literature-updates-episode-8-6713?t=153)
- "The aim of the stem cell study was to see if mesenchymal stem cell based transamniotic stem cell therapy can reduce the inflammation of the fetal brain in intrauterine growth restriction" — Cecilia Gigena (clinical) [Ep 14 · 2:33](https://library.globalcastmd.com/watch/quick-literature-updates-episode-8-6713?t=153)
- "In the IUGR study, subjects were divided into four groups: untreated, saline only, transamniotic stem cell therapy, and mesenchymal stem cells with a primer" — Cecilia Gigena (clinical) [Ep 14 · 2:33](https://library.globalcastmd.com/watch/quick-literature-updates-episode-8-6713?t=153)
- "The overall survival in the IUGR stem cell study was 75%" — Cecilia Gigena (clinical) [Ep 14 · 2:33](https://library.globalcastmd.com/watch/quick-literature-updates-episode-8-6713?t=153)
- "Gross brain weight was significantly lower in IUGR patients with no treatment or just saline, and significantly higher in those treated with MSC" — Cecilia Gigena (clinical) [Ep 14 · 2:33](https://library.globalcastmd.com/watch/quick-literature-updates-episode-8-6713?t=153)
- "The primed MSC group revealed significantly lowered levels of TNF alpha and interleukin beta in their brain" — Britney Levy (clinical) [Ep 14 · 3:43](https://library.globalcastmd.com/watch/quick-literature-updates-episode-8-6713?t=223)
- "Primed MSC appears to reverse some of the central nervous system effects of intrauterine growth restriction" — Britney Levy (opinion) [Ep 14 · 3:43](https://library.globalcastmd.com/watch/quick-literature-updates-episode-8-6713?t=223)
- "The tracheostomy timing study used data from the National Trauma Data Bank with over 40,000 adolescent trauma victims who were intubated for more than 24 hours and survived until discharge" — Britney Levy (clinical) [Ep 14 · 3:43](https://library.globalcastmd.com/watch/quick-literature-updates-episode-8-6713?t=223)
- "The tracheostomy study analyzed patients with TBI and non-TBI separately, looking at both three and seven days for tracheostomy timing" — Britney Levy (clinical) [Ep 14 · 3:43](https://library.globalcastmd.com/watch/quick-literature-updates-episode-8-6713?t=223)
- "At three days, there was no difference in overall hospital length of stay for tracheostomy timing" — Britney Levy (clinical) [Ep 14 · 3:43](https://library.globalcastmd.com/watch/quick-literature-updates-episode-8-6713?t=223)
- "In kids without TBI, tracheostomy before three days resulted in decreased ICU length of stay by about 16 days less than ICU" — Britney Levy (clinical) [Ep 14 · 3:43](https://library.globalcastmd.com/watch/quick-literature-updates-episode-8-6713?t=223)
- "Similar trends for decreased ICU stay were seen for all children, regardless of TBI or non-TBI status, if they received a tracheostomy before 7 days of intubation" — Britney Levy (clinical) [Ep 14 · 3:43](https://library.globalcastmd.com/watch/quick-literature-updates-episode-8-6713?t=223)
- "The Eastern Pediatric Surgery Network in the US created a survey distributed among pediatric surgeons to understand current practices of esophageal surveillance in esophageal atresia patients" — Cecilia Gigena (epidemiological) [Ep 15 · 0:00](https://library.globalcastmd.com/watch/esophageal-surveillance-practices-in-esophageal-atresia-patients-6844?t=0)
- "139 pediatric surgeons responded to the survey" — Cecilia Gigena (epidemiological) [Ep 15 · 0:30](https://library.globalcastmd.com/watch/esophageal-surveillance-practices-in-esophageal-atresia-patients-6844?t=30)
- "75% of respondents strongly agree or agree with current esophageal atresia surveillance guidelines" — Cecilia Gigena (epidemiological) [Ep 15 · 0:40](https://library.globalcastmd.com/watch/esophageal-surveillance-practices-in-esophageal-atresia-patients-6844?t=40)
- "Only 37% of respondents reported that their esophageal atresia patients have pre-determined outpatient clinic follow-up schedule" — Cecilia Gigena (epidemiological) [Ep 15 · 0:50](https://library.globalcastmd.com/watch/esophageal-surveillance-practices-in-esophageal-atresia-patients-6844?t=50)
- "80% of respondents agree or strongly agree that endoscopy should follow a set schedule" — Cecilia Gigena (epidemiological) [Ep 15 · 1:05](https://library.globalcastmd.com/watch/esophageal-surveillance-practices-in-esophageal-atresia-patients-6844?t=65)
- "Only 37% of respondents perform follow-up endoscopy regardless of symptoms" — Cecilia Gigena (epidemiological) [Ep 15 · 1:20](https://library.globalcastmd.com/watch/esophageal-surveillance-practices-in-esophageal-atresia-patients-6844?t=80)
- "There is high agreement with current esophageal atresia surveillance guidelines but weak adherence to them" — Cecilia Gigena (opinion) [Ep 15 · 1:35](https://library.globalcastmd.com/watch/esophageal-surveillance-practices-in-esophageal-atresia-patients-6844?t=95)
- "In a 7-year-old boy, a 2-centimeter transverse incision is placed midway between the cricoid cartilage and the suprasternal notch for tracheostomy." — Tamer Ashraf Wafa (clinical) [Ep 9 · 0:00](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=0)
- "If the anterior jugular vein is encountered during tracheostomy, it is coagulated and cut." — Tamer Ashraf Wafa (clinical) [Ep 9 · 0:30](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=30)
- "The deep cervical fascia is split in a vertical fashion during pediatric tracheostomy." — Tamer Ashraf Wafa (clinical) [Ep 9 · 0:40](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=40)
- "The thyroid isthmus can be cauterized and divided, or retracted downwards." — Tamer Ashraf Wafa (clinical) [Ep 9 · 1:00](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=60)
- "In children, the third and fourth tracheal rings are the best level for tracheostomy opening." — Tamer Ashraf Wafa (clinical) [Ep 9 · 1:30](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=90)
- "Two non-absorbable stay sutures are placed on both sides of the tracheostomy opening and left in place for post-operative reinsertion of the tube if needed." — Tamer Ashraf Wafa (clinical) [Ep 9 · 1:40](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=100)
- "The side of the tracheal incision is cauterized with bipolar diathermy to minimize bleeding." — Tamer Ashraf Wafa (clinical) [Ep 9 · 1:55](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=115)
- "The trachea is sharply incised vertically for tracheostomy." — Tamer Ashraf Wafa (clinical) [Ep 9 · 2:05](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=125)
- "Suction should be continuously applied during tracheal incision to prevent blood from entering the airway." — Tamer Ashraf Wafa (clinical) [Ep 9 · 2:10](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=130)
- "Pulling the stay sutures laterally helps opening the tracheal lumen." — Tamer Ashraf Wafa (clinical) [Ep 9 · 2:20](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=140)
- "The tracheal opening should be widened just enough to admit the suitable tube." — Tamer Ashraf Wafa (clinical) [Ep 9 · 2:25](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=145)
- "The endotracheal tube is pulled back to the level of the tracheostomy opening before inserting the tracheostomy tube." — Tamer Ashraf Wafa (clinical) [Ep 9 · 2:30](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=150)
- "After tracheostomy tube insertion, air entry is checked on both lungs." — Tamer Ashraf Wafa (clinical) [Ep 9 · 2:40](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=160)
- "The angles of the tracheostomy wound are approximated using absorbable sutures." — Tamer Ashraf Wafa (clinical) [Ep 9 · 2:45](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=165)
- "The neck is flexed and the tracheostomy tube is tied tightly around it." — Tamer Ashraf Wafa (clinical) [Ep 9 · 2:50](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=170)
- "The stay sutures are taped to the chest and should not be removed, as written clearly on the tape." — Tamer Ashraf Wafa (clinical) [Ep 9 · 2:53](https://library.globalcastmd.com/watch/pediatric-tracheostomy-in-a-7-year-old-child-dr-tamer-ashraf-wafa-4151?t=173)
- "A laryngeal cleft is a congenital condition in which the posterior wall of the laryngotracheal tract is open and food or liquids can pass from the esophagus into the trachea, leading to aspirations" — Michael Rutter (clinical) [Ep 10 · 0:59](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=59)
- "Type 1 laryngeal cleft means the opening is above the vocal cords" — Rod Gerardo (clinical) [Ep 10 · 1:41](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=101)
- "Type 2 laryngeal cleft means it extends below the vocal cords" — Rod Gerardo (clinical) [Ep 10 · 1:41](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=101)
- "Type 3 laryngeal cleft means it extends down into the trachea" — Rod Gerardo (clinical) [Ep 10 · 1:41](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=101)
- "Type 4 cleft could be proximal above the carina, at the carina, or go straight through the carina" — Rod Gerardo (clinical) [Ep 10 · 1:41](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=101)
- "Flexible bronchoscopy is not adequate for diagnosing a posterior laryngeal cleft" — Rod Gerardo (clinical) [Ep 10 · 1:41](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=101)
- "The endoscopic mass closure technique uses the concept of raw against raw surfaces, as mucosa is a nonstick surface" — Rod Gerardo (clinical) [Ep 10 · 3:43](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=223)
- "KTP laser or CO2 laser can be used for demucosalization, whichever is available in the armamentarium" — Alessandro Dialicon (clinical) [Ep 10 · 3:43](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=223)
- "Open approach is reserved for failed endoscopic repair, some type 2s and type 3s" — Michael Rutter (clinical) [Ep 10 · 4:15](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=255)
- "Type 4 clefts use a laryngofissure approach for cervical cases" — Michael Rutter (clinical) [Ep 10 · 4:15](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=255)
- "Type 4 long clefts present anesthetic challenges that may require double lumen tube, single lung ventilation, ECMO or bypass" — Michael Rutter (clinical) [Ep 10 · 4:15](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=255)
- "Type 4 long clefts often have associated microgastria and multiple other congenital anomalies" — Michael Rutter (clinical) [Ep 10 · 4:15](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=255)
- "There is a very high mortality rate with type 4 long cleft patients, approximately 50%" — Michael Rutter (epidemiological) [Ep 10 · 4:15](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=255)
- "Most type 3 clefts are attempted endoscopically unless there is a reason to go open" — Michael Rutter (clinical) [Ep 10 · 7:00](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=420)
- "The transtracheal technique for type 4 clefts involves forming layers between trachea and esophagus, sewing the esophageal layer with knots in lumen and the tracheal layer with knots in lumen" — Michael Rutter (clinical) [Ep 10 · 7:00](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=420)
- "An interposition graft can be used in the transtracheal technique" — Michael Rutter (clinical) [Ep 10 · 7:00](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=420)
- "The novel technique for type 4 long clefts involves transecting the trachea at the lower border of the cricoid and peeling the trachea off the esophagus" — Michael Rutter (clinical) [Ep 10 · 8:53](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=533)
- "The patient can be kept intubated into one bronchus during the type 4 long repair" — Michael Rutter (clinical) [Ep 10 · 8:53](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=533)
- "Sternal periosteum or tibial periosteum can be used as interposition graft material" — Michael Rutter (clinical) [Ep 10 · 8:53](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=533)
- "Tracheostomy is placed relatively late, two or three weeks after the type 4 long repair" — Michael Rutter (clinical) [Ep 10 · 8:53](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=533)
- "Waiting until the child is greater than five kilograms is based on outcomes data from previous research" — Michael Rutter (clinical) [Ep 10 · 10:16](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=616)
- "For long clefts, a large endotracheal tube like 4.5 should be used" — Michael Rutter (clinical) [Ep 10 · 10:16](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=616)
- "Children with laryngeal clefts have a very short trachea" — Michael Rutter (clinical) [Ep 10 · 10:16](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=616)
- "The biggest risk with laryngotracheal esophageal clefts is that the distal end turns into a tracheoesophageal fistula" — Michael Rutter (clinical) [Ep 10 · 10:16](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=616)
- "A cuffed endotracheal tube can be placed in the esophagus to show where a tracheoesophageal fistula is located" — Michael Rutter (clinical) [Ep 10 · 10:16](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=616)
- "Transtracheal three-layer closure can be performed on extremely thin mucosa" — Michael Rutter (clinical) [Ep 10 · 10:16](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=616)
- "Residual tracheoesophageal fistula can be repaired endoscopically using bugbee cautery for demucosalization and endoscopic suturing" — Michael Rutter (clinical) [Ep 10 · 10:16](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=616)
- "Endoscopic suture repair of tracheoesophageal fistula is easier in older children than younger children" — Michael Rutter (opinion) [Ep 10 · 10:16](https://library.globalcastmd.com/watch/laryngeal-clefts-4226?t=616)
- "Prior to the 1970s, endoscopic surgery using bougie dilation was the mainstay of airway stenosis management" — Brittany (clinical) [Ep 12 · 1:34](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=94)
- "Bougie dilation involved a lot of shear forces and quite a lot of mucosal damage" — Michael Rutter (clinical) [Ep 12 · 1:34](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=94)
- "The development of open airway surgery in the 1970s allowed for costocartilage grafts and laryngotracheal reconstruction" — Michael Rutter (clinical) [Ep 12 · 1:34](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=94)
- "You shouldn't balloon dilate complete tracheal rings because you might rupture them" — Brittany (clinical) [Ep 12 · 2:35](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=155)
- "Balloon dilating tracheal malacia will achieve nothing" — Brittany (clinical) [Ep 12 · 2:35](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=155)
- "It's not useful to balloon dilate a tracheal A-frame deformity or an elliptical cricoid because you've got a framework problem" — Brittany (clinical) [Ep 12 · 2:35](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=155)
- "Endoluminal dilation is best for patients with an intraluminal scar and an intact framework" — Brittany (clinical) [Ep 12 · 2:35](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=155)
- "The advantage of balloon dilation is all of the dilation is radial with no shear forces involved" — Brittany (clinical) [Ep 12 · 2:35](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=155)
- "Balloon dilators are single use and can get pretty expensive" — Brittany (clinical) [Ep 12 · 2:35](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=155)
- "We inflate the balloon to the rated burst pressure and hold pressure for two minutes or until the oxygen saturations drop to 90%, whichever happens first" — Michael Rutter (clinical) [Ep 12 · 4:26](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=266)
- "If you dilate a balloon in a stenosis, you keep having to add water to the syringe pump as the pressure keeps dropping for about 90 seconds as the fibrous tissue is stretched open" — Michael Rutter (clinical) [Ep 12 · 5:26](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=326)
- "Some patients have a complete and sustained improvement after a single dilation" — Brittany (clinical) [Ep 12 · 6:27](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=387)
- "For patients that require a return trip to the operating room for a second dilation, adjunctive scar removing procedures can be beneficial" — Brittany (clinical) [Ep 12 · 6:27](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=387)
- "We typically inject some Kenalog with the orotracheal injector set and then divide the scar bands, typically in a Mercedes-Star incision, with a blitzer knife" — Michael Rutter (clinical) [Ep 12 · 7:04](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=424)
- "The technique is to place the blitzer knife with the point away from the airway, get it into the stenosis, then turn it 180 degrees and cut towards the lumen for a much better result" — Michael Rutter (clinical) [Ep 12 · 7:33](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=453)
- "Endoscopic dilation works regardless of whether the stenosis is in the larynx or in the trachea" — Brittany (clinical) [Ep 12 · 7:48](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=468)
- "At Cincinnati Children's Hospital, we've been doing endoscopic dilations for about 20 years and have dilated thousands of patients" — Brittany (epidemiological) [Ep 12 · 8:31](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=511)
- "The protocol for dilation is to usually dilate three or four times at seven to ten day intervals for established scar" — Michael Rutter (clinical) [Ep 12 · 9:33](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=573)
- "On the second dilation, we may inject Kenalog, may divide some scar tissue, may increase the balloon size, and may consider nebulizing cipridex if there are significant raw areas after the dilation" — Michael Rutter (clinical) [Ep 12 · 9:33](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=573)
- "If after five dilations you are not winning, you should take a step back and think, should I be doing something else" — Michael Rutter (opinion) [Ep 12 · 9:33](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=573)
- "The ideal candidate for balloon dilation is thin scar, young scar" — Michael Rutter (clinical) [Ep 12 · 10:28](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=628)
- "The formula for balloon sizing is to take the outer diameter of an age-appropriate endotracheal tube and add one millimeter for the larynx and two millimeters for the trachea" — Brittany (clinical) [Ep 12 · 10:55](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=655)
- "A free mobile app is available to help choose the right size balloon to minimize risk" — Michael Rutter (clinical) [Ep 12 · 11:17](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=677)
- "In patients with an intact laryngeal tracheal exoskeleton with fresher thin webs, endoscopic dilation works pretty well" — Brittany (clinical) [Ep 12 · 11:52](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=712)
- "If there's thick and fixed scar, endoscopic dilation may need to be coupled with adjuvant procedures" — Brittany (clinical) [Ep 12 · 11:52](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=712)
- "You may need to consider an open procedure if sequential dilations just aren't successful" — Brittany (clinical) [Ep 12 · 11:52](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=712)
- "For posterior glottic stenosis, greater than grade three posterior subglottic stenosis, or bilateral vocal cord paralysis, balloon dilation just isn't enough" — Brittany (clinical) [Ep 12 · 11:52](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=712)
- "It's easier to do open procedures in a patient with a tracheotomy, but it's not required as long as you can keep the child spontaneously breathing while under anesthesia" — Michael Rutter (clinical) [Ep 12 · 12:58](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=778)
- "For posterior cricoid split, you divide the posterior cricoid using a sickle knife and micro scissors, and once divided it will pop open" — Michael Rutter (clinical) [Ep 12 · 12:58](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=778)
- "A balloon can be placed anteriorly and as you inflate it, it pushes the cartilage graft into place" — Michael Rutter (clinical) [Ep 12 · 13:39](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=819)
- "For minor laryngeal webs, an endoscopic repair is feasible and you don't necessarily need a tracheotomy tube" — Michael Rutter (clinical) [Ep 12 · 14:18](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=858)
- "After dividing a web, you've got one raw surface against another raw surface, so you need to let those mucosalize or they will re-adhere" — Michael Rutter (clinical) [Ep 12 · 14:18](https://library.globalcastmd.com/watch/laryngotracheal-stenosis-5406?t=858)
- "The article was published in the Journal of Pediatric Critical Care Medicine in 2021" — Brittany Levy (clinical) [Ep 13 · 0:00](https://library.globalcastmd.com/watch/article-of-interest-optimal-timing-of-tracheostomy-in-injured-adolescents-5788?t=0)
- "The authors analyzed data from the National Trauma Data Bank" — Brittany Levy (clinical) [Ep 13 · 0:00](https://library.globalcastmd.com/watch/article-of-interest-optimal-timing-of-tracheostomy-in-injured-adolescents-5788?t=0)
- "The study included over 40,000 adolescent trauma victims who were intubated for more than 24 hours and survived until discharge" — Brittany Levy (epidemiological) [Ep 13 · 0:00](https://library.globalcastmd.com/watch/article-of-interest-optimal-timing-of-tracheostomy-in-injured-adolescents-5788?t=0)
- "The study stratified patients into TBI and non-TBI groups" — Brittany Levy (clinical) [Ep 13 · 0:00](https://library.globalcastmd.com/watch/article-of-interest-optimal-timing-of-tracheostomy-in-injured-adolescents-5788?t=0)
- "At 3 days, there was no difference in overall hospital length of stay" — Brittany Levy (clinical) [Ep 13 · 0:00](https://library.globalcastmd.com/watch/article-of-interest-optimal-timing-of-tracheostomy-in-injured-adolescents-5788?t=0)
- "In non-TBI patients, tracheostomy before 3 days decreased ICU length of stay by approximately 16 days" — Brittany Levy (clinical) [Ep 13 · 0:00](https://library.globalcastmd.com/watch/article-of-interest-optimal-timing-of-tracheostomy-in-injured-adolescents-5788?t=0)
- "Similar trends were seen for all children regardless of TBI or non-TBI status if they received tracheostomy before 7 days of intubation" — Brittany Levy (clinical) [Ep 13 · 0:00](https://library.globalcastmd.com/watch/article-of-interest-optimal-timing-of-tracheostomy-in-injured-adolescents-5788?t=0)

## Common questions
### More info about tracheostomy?
Tracheostomy involves creating an opening in the trachea to bypass upper airway obstruction. In pediatric cases, a 2-cm transverse incision is placed midway between the cricoid cartilage and suprasternal notch, with the third and fourth tracheal rings serving as the optimal level. The trachea is sharply incised vertically, and non-absorbable stay sutures are placed bilaterally for postoperative tube reinsertion. After tube insertion, air entry is verified on both lungs. Early tracheostomy (before 7 days of intubation) in children decreases ICU length of stay regardless of traumatic brain injury status. In non-TBI patients, tracheostomy before 3 days reduced ICU stay by approximately 16 days.

## Changelog
- Aug 31: 38 doctors auto-found from episode dossiers
- Aug 30: 32 doctors auto-found from episode dossiers
- Aug 30: 27 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 74 doctors auto-found from episode dossiers
- Aug 29: 72 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 55 items, 38 dossiers, summaries for 4 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 45 items, 38 dossiers, summaries for 2 audience(s)
- Aug 29: Collection generated from campaign corpus: 45 items, 38 dossiers, summaries for 2 audience(s)

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