# Pectus Excavatum — GCMD Library living collection

Also covered as: pectus carinatum · Marfan syndrome · scoliosis · mitral valve prolapse · chronic pain · Ehlers-Danlos syndrome · nickel allergy · pneumothorax

Experts: Dr. Cecilia Gigena, Dr. Victor Garcia, Dr. Todd Ponsky, Dr. Ellen Encisco

Updated: n/a · 58 episodes · 1260 cited statements

## Episodes
### Diagnosis & Workup
- [Pectus - Preoperative Assessment - Radiology and Cardiac Evaluation](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692) — video · 44:03 · [machine version](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692.md)
- [Pectus - Preoperative Assessment - Genetics](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691) — video · 9:54 · [machine version](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691.md)
- [Radiology: Pectus Innovations](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019) — video · 38:47 · [machine version](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019.md)
- [Genetics: Pectus Innovations](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018) — video · 9:48 · [machine version](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018.md)
- [Pectus Arcuatum a Pectus Unlike any Other](https://library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899) — video · 0:51 · [machine version](https://library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899.md)

### Surgical Management
- [Pectus Deformities: Update Course 2015](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671) — video · 34:58 · [machine version](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671.md)
- [Pectus Excavatum Pain Management at Cincinnati Children's Hospital](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693) — video · 54:09 · [machine version](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693.md)
- [Pectus Deformities: Update Course 2015](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990) — video · 34:40 · [machine version](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990.md)
- [Criteria for Pectus Repair: Update Course 2015](https://library.globalcastmd.com/watch/criteria-for-pectus-repair-update-course-2015-997) — video · 0:55 · [machine version](https://library.globalcastmd.com/watch/criteria-for-pectus-repair-update-course-2015-997.md)
- [Pain Management: Pectus Innovations](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015) — video · 54:09 · [machine version](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015.md)
- [Minimally Invasive Repair of Pectus Carinatum](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953) — video · 5:00 · [machine version](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953.md)
- [Minimally Invasive Repair of Pectus Carinatum](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954) — video · 5:00 · [machine version](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954.md)
- [Pectus Excavatum Pathway](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973) — video · 5:09 · [machine version](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973.md)
- [Update Course Rewind: Cryoanalgesia in Pectus Cases 2024](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194) — video · 7:34 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194.md)
- [Update Course Rewind: Part 1 Non-Pectus Uses of Cryoanalgesia 2024](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574) — video · 4:25 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574.md)
- [Update Course Rewind: Part 2 Non-Pectus Uses of Cryoanalgesia 2024](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622) — video · 4:23 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622.md)

### Complications
- [Pectus - Surgical Approaches for Failed Repair](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689) — video · 44:25 · [machine version](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689.md)
- [Interesting Cases & Surgical Approaches: Pectus Innovations](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016) — video · 44:14 · [machine version](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016.md)

### Evidence & Research
- [Pectus - Physiologic Consequences and Research](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688) — video · 22:32 · [machine version](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688.md)
- [Physiology: Pectus Innovations](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017) — video · 21:01 · [machine version](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017.md)
- [Stay Current Journal Club: Episode 1 - Ventricular Dysfunction in CDH and...](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689) — podcast · 16:50 · [machine version](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689.md)
- [APSA - Is same day discharge possible following the Nuss repair for pectus excavatum - R. Luke Rettig](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422) — video · 7:57 · [machine version](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422.md)
- [BOB Ped Surg 2023 - Joshua Ramjist, CAPS  - Presentation](https://library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351) — video · [machine version](https://library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351.md)
- [BOB Ped Surg 2023 - Brittany Hegde, PAPS  - Presentation](https://library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359) — video · [machine version](https://library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359.md)
- [Novel index to estimate the cephalocaudal extent of the excavation in pectus excavatum - JPS article](https://library.globalcastmd.com/watch/novel-index-to-estimate-the-cephalocaudal-extent-of-the-excavation-in-pectus-excavatum-jps-article-6617) — video · 1:13 · [machine version](https://library.globalcastmd.com/watch/novel-index-to-estimate-the-cephalocaudal-extent-of-the-excavation-in-pectus-excavatum-jps-article-6617.md)
- [Novedoso indice para estimar la extensión cefalocaudal del hundimiento esternal en el pectus excavatum: El Índice Titanic](https://library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619) — video · [machine version](https://library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619.md)
- [Journal of pediatric surgery Article Review: April 2023, IPEG issue](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959) — podcast · 13:22 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959.md)
- [Cost and outcomes of intercostal nerve cryoablation versus thoracic epidural following the Nuss procedure](https://library.globalcastmd.com/watch/cost-and-outcomes-of-intercostal-nerve-cryoablation-versus-thoracic-epidural-following-the-nuss-procedure-7313) — video · 1:07 · [machine version](https://library.globalcastmd.com/watch/cost-and-outcomes-of-intercostal-nerve-cryoablation-versus-thoracic-epidural-following-the-nuss-procedure-7313.md)
- [Cryoablation in 350 Nuss procedures](https://library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334) — video · 0:56 · [machine version](https://library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334.md)
- [Crioablación en 350 procedimientos de Nuss: evolución de la duración de la estancia hospitalaria y el uso de opioides](https://library.globalcastmd.com/watch/crioablaci-n-en-350-procedimientos-de-nuss-evoluci-n-de-la-duraci-n-de-la-estancia-hospitalaria-y-el-uso-de-opioides-7335) — video · 0:59 · [machine version](https://library.globalcastmd.com/watch/crioablaci-n-en-350-procedimientos-de-nuss-evoluci-n-de-la-duraci-n-de-la-estancia-hospitalaria-y-el-uso-de-opioides-7335.md)
- [Initial Outcomes Using Cryoablation in Surgical Management of Slipping Rib Syndrome](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456) — video · 1:03 · [machine version](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456.md)
- [Resultados iniciales del uso de crioablación en el tratamiento quirúrgico del síndrome de costilla deslizante](https://library.globalcastmd.com/watch/resultados-iniciales-del-uso-de-crioablaci-n-en-el-tratamiento-quir-rgico-del-s-ndrome-de-costilla-deslizante-7467) — video · 0:57 · [machine version](https://library.globalcastmd.com/watch/resultados-iniciales-del-uso-de-crioablaci-n-en-el-tratamiento-quir-rgico-del-s-ndrome-de-costilla-deslizante-7467.md)
- [Quick Literature Updates Episode 13](https://library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638) — video · 4:12 · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638.md)
- [Impact of Cryoanalgesia Use During Minimally Invasive Pectus Excavatum Repair on Hospital Days and Total Hospital Costs Among Pediatric Patients](https://library.globalcastmd.com/watch/impact-of-cryoanalgesia-use-during-minimally-invasive-pectus-excavatum-repair-on-hospital-days-and-total-hospital-costs-among-pediatric-patients-7862) — video · 0:59 · [machine version](https://library.globalcastmd.com/watch/impact-of-cryoanalgesia-use-during-minimally-invasive-pectus-excavatum-repair-on-hospital-days-and-total-hospital-costs-among-pediatric-patients-7862.md)
- [Impacto de la Crioanalgesia durante la reparación del Pectus Excavatum en la estadia hospitalaria y los costos en la población pediátrica](https://library.globalcastmd.com/watch/impacto-de-la-crioanalgesia-durante-la-reparaci-n-del-pectus-excavatum-en-la-estadia-hospitalaria-y-los-costos-en-la-poblaci-n-pedi-trica-7863) — video · 0:52 · [machine version](https://library.globalcastmd.com/watch/impacto-de-la-crioanalgesia-durante-la-reparaci-n-del-pectus-excavatum-en-la-estadia-hospitalaria-y-los-costos-en-la-poblaci-n-pedi-trica-7863.md)
- [Journal of Pediatric Surgery Article Review: July 2023, PAPS Issue](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900) — podcast · 10:46 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900.md)
- [Journal of Pediatric Surgery Article Review: September 2023](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057) — podcast · 13:31 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057.md)
- [Long-Term Sensory Function 3 years after Minimally Invasive Repair of Pectus Excavatum with Cryoablation](https://library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729) — video · 1:19 · [machine version](https://library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729.md)
- [Journal of Pediatric Surgery Article Review: Q1 (Jan-Mar) 2024](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754) — podcast · 13:34 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754.md)
- [Pectus Bar Dislocation: Comparison Between Three Different Stabilization Techniques Adopted in a Single Centre](https://library.globalcastmd.com/watch/pectus-bar-dislocation-comparison-between-three-different-stabilization-techniques-adopted-in-a-single-centre-9184) — video · 1:02 · [machine version](https://library.globalcastmd.com/watch/pectus-bar-dislocation-comparison-between-three-different-stabilization-techniques-adopted-in-a-single-centre-9184.md)
- [Six Years of Quality Improvement in Pectus Excavatum Repair: Implementation of Intercostal Nerve Cryoablation and ERAS Protocols for Patients Undergoing Nuss Procedure](https://library.globalcastmd.com/watch/six-years-of-quality-improvement-in-pectus-excavatum-repair-implementation-of-intercostal-nerve-cryoablation-and-eras-protocols-for-patients-undergoing-nuss-procedure-10353) — video · 0:51 · [machine version](https://library.globalcastmd.com/watch/six-years-of-quality-improvement-in-pectus-excavatum-repair-implementation-of-intercostal-nerve-cryoablation-and-eras-protocols-for-patients-undergoing-nuss-procedure-10353.md)
- [Vacuum Bell Therapy for Pectus Excavatum: Long-term Experience at a Single Center](https://library.globalcastmd.com/watch/vacuum-bell-therapy-for-pectus-excavatum-long-term-experience-at-a-single-center-10404) — video · 0:58 · [machine version](https://library.globalcastmd.com/watch/vacuum-bell-therapy-for-pectus-excavatum-long-term-experience-at-a-single-center-10404.md)
- [Cardiopulmonary Impact of the Minimally Invasive Repair of Pectus Excavatum in Pediatric Patients: A Prospective Pilot Study](https://library.globalcastmd.com/watch/cardiopulmonary-impact-of-the-minimally-invasive-repair-of-pectus-excavatum-in-pediatric-patients-a-prospective-pilot-study-10436) — video · 0:55 · [machine version](https://library.globalcastmd.com/watch/cardiopulmonary-impact-of-the-minimally-invasive-repair-of-pectus-excavatum-in-pediatric-patients-a-prospective-pilot-study-10436.md)
- [Journal of Pediatric Surgery Article Review: 1st Quarter (Jan-Mar) 2025](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484) — podcast · 16:35 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484.md)
- [Quick Literature Updates Ep 24](https://library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235) — video · 4:42 · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235.md)

### In-Depth Reviews
- [An Update on Chest Wall Anomalies and Their Treatment: Advanced Practice...](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423) — video · 46:05 · [machine version](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423.md)
- [Chest Wall Deformities with Dr. Robert Kelly](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305) — podcast · 46:50 · [machine version](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305.md)
- [Update Course Rewind 2021 - Updates in Pectus](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411) — video · 61:14 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411.md)
- [Update Course Rewind: Pectus Excavatum 2021](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806) — podcast · 11:56 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806.md)
- [Update Course Rewind: Pectus Excavatum 2021](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807) — video · 11:56 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807.md)
- [Update Course Rewind: 2024 Top Ten Key Takeaways](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526) — video · 18:01 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526.md)
- [Update Course Rewind: 2024 Top Ten Key Takeaways](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593) — podcast · 18:01 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593.md)
- [Update Course Rewind: Pectus Excavatum 2021](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668) — podcast · 11:55 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668.md)
- [Update Course Rewind: Pectus Excavatum 2021](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669) — podcast · 11:55 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669.md)
- [Update Course Rewind: Pectus Excavatum 2021](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670) — podcast · 11:55 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670.md)

### Patient & Family Education
- [Pectus - Patient and Family Education](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690) — video · 19:07 · [machine version](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690.md)
- [Patient Testimonial and Experience: Pectus Innovations](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014) — video · 13:55 · [machine version](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014.md)
- [Pectus-Patient Testimonial and Experience](https://library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241) — video · 14:33 · [machine version](https://library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=0) Introduction and Context (Ep 43)
- [0:17](https://library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=17) Study Design and Methods (Ep 43)
- [0:44](https://library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=44) Results and Conclusions (Ep 43)
- [0:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=0) Introduction and Episode Overview (Ep 44)
- [1:22](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=82) Article 1: Antibiotic Cessation in Complicated Appendicitis (Ep 44)
- [4:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=252) Article 2: Esophageal Lengthening Procedures in Complex EA (Ep 44)
- [8:28](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=508) Article 3: Long-term Sensory Function After Pectus Repair with Cryoablation (Ep 44)
- [12:01](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=721) Summary and Closing (Ep 44)
- [0:00](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=0) Introduction and Patient Selection (Ep 17)
- [1:11](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=71) Surgical Preparation and Marking (Ep 17)
- [2:22](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=142) Rib Protector and Cable Placement (Ep 17)
- [3:27](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=207) Bar Insertion and Fixation (Ep 17)
- [4:32](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=272) Closure and Results (Ep 17)
- [0:00](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=0) Introduction and Patient Selection (Ep 18)
- [1:11](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=71) Surgical Preparation and Initial Dissection (Ep 18)
- [2:22](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=142) Rib Protector and Cable Placement (Ep 18)
- [3:27](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=207) Bar Placement and Fixation (Ep 18)
- [4:36](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=276) Closure and Results (Ep 18)
- [0:05](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=5) Introduction and Preoperative Preparation (Ep 19)
- [0:46](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=46) Postoperative Day 0 Management (Ep 19)
- [1:43](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=103) Postoperative Days 1-2 Progression (Ep 19)
- [2:49](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=169) Postoperative Day 3 and Discharge (Ep 19)
- [4:41](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=281) Pathway Outcomes (Ep 19)
- [0:00](https://library.globalcastmd.com/watch/pectus-bar-dislocation-comparison-between-three-different-stabilization-techniques-adopted-in-a-single-centre-9184?t=0) Bridge vs Single Bar Fixation for Pectus Excavatum (Ep 45)
- [0:16](https://library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=16) Pectus Bar Stabilization Techniques (Ep 54)
- [1:50](https://library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=110) Machine Learning for Appendicitis Diagnosis (Ep 54)
- [3:13](https://library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=193) Transcystic CBD Exploration vs ERCP (Ep 54)
- [0:00](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=0) Introduction and Guest Background (Ep 20)
- [1:23](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=83) Clinical Evaluation and Physical Examination (Ep 20)
- [7:21](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=441) Diagnostic Workup and Surgical Indications (Ep 20)
- [15:21](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=921) Preoperative Planning and Patient Preparation (Ep 20)
- [21:05](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1265) Nuss Procedure Technical Details (Ep 20)
- [31:03](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1863) Postoperative Management and Complications (Ep 20)
- [37:12](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2232) Non-operative Treatment and Pectus Carinatum (Ep 20)
- [42:08](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2528) Surgical Options for Carinatum and Closing (Ep 20)
- [0:06](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=6) Overview of Chest Wall Deformities and Pectus Excavatum (Ep 1)
- [3:53](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=233) Diagnostic Evaluation and Imaging Protocols (Ep 1)
- [7:36](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=456) Preoperative Assessment and Historical Surgical Approaches (Ep 1)
- [13:21](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=801) Emerging Non-Surgical Technologies (Ep 1)
- [18:15](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1095) Pectus Carinatum Management (Ep 1)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Repair of pectus excavatum using minimally invasive techniques with intercostal nerve cryoablation decreases patient length of stay and opioid use" — Kim Priven (clinical) [Ep 43 · 0:00](https://library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=0)
- "This was a single institution prospective cohort study of 47 patients under 21 years of age" — Kim Priven (clinical) [Ep 43 · 0:19](https://library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=19)
- "Patients presented for bar removal after a median of two bars were placed for 2.9 years" — Kim Priven (clinical) [Ep 43 · 0:19](https://library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=19)
- "The study assessed patients for chest wall hypoesthesia to cold, soft touch, and pinprick, as well as neuropathic pain" — Kim Priven (clinical) [Ep 43 · 0:35](https://library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=35)
- "46.8% of patients had identifiable chest wall hypoesthesia" — Kim Priven (clinical) [Ep 43 · 0:46](https://library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=46)
- "9.3% of patients had hypoesthesia to cold response" — Kim Priven (clinical) [Ep 43 · 0:46](https://library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=46)
- "7.7% of patients had hypoesthesia to soft touch" — Kim Priven (clinical) [Ep 43 · 0:46](https://library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=46)
- "11.8% of patients had hypoesthesia to pinprick" — Kim Priven (clinical) [Ep 43 · 0:46](https://library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=46)
- "Neuropathic pain symptoms were identified in 13% of patients" — Kim Priven (clinical) [Ep 43 · 0:58](https://library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=58)
- "None of the patients with neuropathic pain symptoms required treatment" — Kim Priven (clinical) [Ep 43 · 0:58](https://library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=58)
- "Pediatric patients who underwent minimally invasive repair with cryoablation will often develop some small areas of hypoesthesia" — Kim Priven (clinical) [Ep 43 · 1:04](https://library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=64)
- "Clinically significant neuropathic pain is rare after minimally invasive pectus excavatum repair with cryoablation" — Kim Priven (clinical) [Ep 43 · 1:04](https://library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=64)
- "The study compared two cohorts defined by time frame before and after implementation of stopping antibiotics at discharge" — Scott Short or Katie Russell (clinical) [Ep 44 · 2:07](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=127)
- "185 patients were in the home antibiotic group and 121 patients in the no home antibiotic group" — Cecilia Gigena (clinical) [Ep 44 · 2:45](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=165)
- "There was no significant difference in deep organ space infection requiring intervention between groups" — Cecilia Gigena (clinical) [Ep 44 · 2:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=175)
- "There was no difference in length of stay between antibiotic groups" — Cecilia Gigena (clinical) [Ep 44 · 3:03](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=183)
- "Secondary outcomes including C. diff infections, superficial site infections, post-operative CT imaging, and readmission showed no difference" — Romeo Ignacio (clinical) [Ep 44 · 3:06](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=186)
- "The study was a 25 year experience describing 220 consecutive infants with esophageal atresia in Newcastle" — Mark Davenport (clinical) [Ep 44 · 4:44](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=284)
- "13% of the 215 esophageal atresia patients had complex esophageal atresia" — Egodi (epidemiological) [Ep 44 · 5:13](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=313)
- "25 patients with complex EA survived the repair: 14 were type A and 11 were type C" — Egodi (clinical) [Ep 44 · 5:24](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=324)
- "Type C esophageal atresia is the most common type and means esophageal atresia with a distal fistula" — Cecilia Gigena (clinical) [Ep 44 · 5:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=343)
- "Type A means pure esophageal atresia with no fistula to the trachea" — Cecilia Gigena (clinical) [Ep 44 · 5:50](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=350)
- "Of 25 survivors, 18 had delayed primary anastomosis and 7 had esophageal replacement" — Egodi (clinical) [Ep 44 · 6:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=360)
- "Two of the esophageal replacements were salvage procedures following failed traction" — Egodi (clinical) [Ep 44 · 6:13](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=373)
- "Only 4 patients with esophageal atresia were potentially treatable by traction" — Egodi (clinical) [Ep 44 · 6:13](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=373)
- "The esophagus has a great intrinsic blood supply and can be mobilized right down to the diaphragm and up to the thoracic inlet while staying alive" — Bruce Jeffrey (clinical) [Ep 44 · 6:28](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=388)
- "Native esophagus was retained in 80% of cases where traction techniques had not been attempted" — Egodi (clinical) [Ep 44 · 6:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=417)
- "Median time to esophageal continuity was 77 days" — Egodi (clinical) [Ep 44 · 7:02](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=422)
- "Management of complex esophageal atresia without lengthening procedures can result in similar rates of native esophagus retention but with significantly less morbidity" — Egodi (clinical) [Ep 44 · 7:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=432)
- "The pectus study enrolled 47 patients with median bar dwell time of approximately 2.9 years" — Cecilia Gigena (clinical) [Ep 44 · 9:25](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=565)
- "Patients had a median of 2 bars placed, with almost 81% secured with pericostal sutures" — Cecilia Gigena (clinical) [Ep 44 · 9:41](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=581)
- "About half of the patients had some degree of hypoesthesia" — Cecilia Gigena (clinical) [Ep 44 · 9:51](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=591)
- "T5 was the most common dermatome with hypoesthesia" — Cecilia Gigena (clinical) [Ep 44 · 9:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=596)
- "The area with hypoesthesia was less than 5% of the entire surface treated with cryo" — Cecilia Gigena (clinical) [Ep 44 · 10:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=600)
- "Neuropathic symptoms were identified by only 13% of patients and none required treatment" — Cecilia Gigena (clinical) [Ep 44 · 10:18](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=618)
- "Long-term chest wall hypoesthesia after minimally invasive pectus repair with cryo is limited to one or two dermatomes and chronic symptomatic neuropathic pain is very rare" — Cecilia Gigena (clinical) [Ep 44 · 10:26](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=626)
- "Many cases proposed for lengthening may be because surgeons get cold feet about attempting a primary anastomosis" — Bruce Jeffrey (opinion) [Ep 44 · 6:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=406)
- "Pectus carinatum can be corrected by a number of surgical and non-surgical techniques" (clinical) [Ep 17 · 0:00](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=0)
- "Minimally invasive repair of pectus carinatum (Abramson or reverse Nuss procedure) can correct the pectus without cartilage resection" (clinical) [Ep 17 · 0:08](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=8)
- "Correction pressures between 6 and 7 pounds per square inch indicate moderate stiffness of the chest wall" (clinical) [Ep 17 · 0:27](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=27)
- "The procedure requires Zimmer Biome pectus tray containing tunnelers and bars, plus 4 hole stabilizers, bendable rib protectors, and pioneer sternal cable system" (clinical) [Ep 17 · 0:42](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=42)
- "The procedure is performed under general anesthesia with an epidural catheter for intraoperative and postoperative analgesia" (clinical) [Ep 17 · 0:58](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=58)
- "Prophylactic antibiotics are given and a Foley catheter is inserted and kept for 24 hours" (clinical) [Ep 17 · 1:05](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=65)
- "Bar length is determined by measuring the distance between the two mid-axillary lines at the highest point of the carinatum after correction" (clinical) [Ep 17 · 1:19](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=79)
- "The bar ends should correspond to the intercostal space between the two ribs where the stabilizers will be anchored" (clinical) [Ep 17 · 1:33](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=93)
- "Ribs are cleared of all muscle attachments for a distance of approximately 3 centimeters" (clinical) [Ep 17 · 1:57](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=117)
- "A 1 inch periosteal incision is made in the rib and the periosteum separated from the underlying bone anteriorly and posteriorly" (clinical) [Ep 17 · 2:13](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=133)
- "A rib protector of similar size to the measured subperiosteal space is bent to the shape of the rib and a cable is threaded through its holes" (clinical) [Ep 17 · 2:37](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=157)
- "A small piece of dental wire is used to label the rib protector to facilitate removal from behind the rib in 2 to 3 years" (clinical) [Ep 17 · 2:58](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=178)
- "The cable and protector are passed under the rib within the subperiosteal space" (clinical) [Ep 17 · 2:44](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=164)
- "A tunnel is created between the muscles and the bony chest wall using a long curved clamp and finger dissection from both sides meeting at the midpoint" (clinical) [Ep 17 · 3:27](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=207)
- "Sternal wire is placed around a notch in the bar just distal to the stabilizer to lock the bar and stabilizer in position" (clinical) [Ep 17 · 3:52](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=232)
- "The bar is tightly anchored to 4 ribs, 2 on each side" (clinical) [Ep 17 · 4:24](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=264)
- "The rib protectors prevent the cables from cutting through the ribs" (clinical) [Ep 17 · 4:32](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=272)
- "One year after repair, excellent correction was achieved and maintained" (clinical) [Ep 17 · 4:48](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=288)
- "In addition to correction of the pectus, lateral chest wall expansion occurred" (clinical) [Ep 17 · 4:55](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=295)
- "Pectus carinatum can be corrected by a number of surgical and non-surgical techniques" (clinical) [Ep 18 · 0:00](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=0)
- "Minimally invasive repair of pectus carinatum (Abramson or reverse Nuss procedure) can correct the pectus without cartilage resection" (clinical) [Ep 18 · 0:08](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=8)
- "Correction pressures between 6 and 7 pounds per square inch indicate moderate stiffness of the chest wall" (clinical) [Ep 18 · 0:27](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=27)
- "The procedure is performed under general anesthesia with an epidural catheter for intraoperative and postoperative analgesia" (clinical) [Ep 18 · 0:58](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=58)
- "Prophylactic antibiotics are given and a Foley catheter is inserted and kept for 24 hours" (clinical) [Ep 18 · 1:05](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=65)
- "The bar length is chosen equal to the distance between the two mid-axillary lines at the highest point of the carinatum after correction" (clinical) [Ep 18 · 1:19](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=79)
- "Ribs are cleared of all muscle attachments for a distance of approximately 3 centimeters" (clinical) [Ep 18 · 1:57](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=117)
- "A 1 inch periosteal incision is made in the rib and the periosteum separated from the underlying bone anteriorly and posteriorly" (clinical) [Ep 18 · 2:13](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=133)
- "A small piece of dental wire is used to label the rib protector to facilitate removal from behind the rib in 2 to 3 years" (clinical) [Ep 18 · 2:58](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=178)
- "The bar is tightly anchored to 4 ribs, 2 on each side" (clinical) [Ep 18 · 4:24](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=264)
- "The rib protectors prevent the cables from cutting through the ribs" (clinical) [Ep 18 · 4:32](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=272)
- "One year after repair, excellent correction was achieved and maintained" (clinical) [Ep 18 · 4:48](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=288)
- "In addition to correction of the pectus, lateral chest wall expansion occurred" (clinical) [Ep 18 · 4:55](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=295)
- "The clinical care pathway has five major components: pain management, mobility, lung recruitment, daily intake, and daily output" — Rebecca Brown (clinical) [Ep 19 · 0:19](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=19)
- "Preoperative antibiotic prophylaxis is ANF or vancomycin if the patient is MRSA positive" — Rebecca Brown (guideline) [Ep 19 · 0:33](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=33)
- "Preoperative washes of Dynahex or Hibiclens scrub are applied to prevent infection after surgery" — Rebecca Brown (guideline) [Ep 19 · 0:33](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=33)
- "Patients are given clear liquids and advanced as tolerated to a full regular diet on postoperative day 0" — Rebecca Brown (clinical) [Ep 19 · 0:49](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=49)
- "Incentive spirometry is performed 10 times per hour throughout the postoperative course" — Rebecca Brown (clinical) [Ep 19 · 1:01](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=61)
- "Postoperative antibiotics are ANF times 3 doses, or clindamycin if MRSA positive" — Rebecca Brown (guideline) [Ep 19 · 1:11](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=71)
- "Epidural analgesia is routinely used and supplemented with Valium, Robaxin, Toradol, IV Tylenol, methadone times 1, and scheduled Zofran" — Rebecca Brown (clinical) [Ep 19 · 1:17](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=77)
- "Patients are encouraged to chew gum 5 separate times a day for 20 minutes if fully awake postoperatively" — Rebecca Brown (clinical) [Ep 19 · 1:31](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=91)
- "Bowel management includes Senna and MiraLax twice a day as well as Movantik" — Rebecca Brown (clinical) [Ep 19 · 1:33](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=93)
- "The Foley catheter is removed on postoperative day 1 to encourage ambulation" — Rebecca Brown (clinical) [Ep 19 · 1:56](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=116)
- "Oral oxycodone is started on postoperative day 1 once patients are tolerating a diet" — Rebecca Brown (clinical) [Ep 19 · 2:03](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=123)
- "Maintenance IV fluids are continued until the patient is drinking well and urinates after Foley removal" — Rebecca Brown (clinical) [Ep 19 · 2:21](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=141)
- "Zofran is changed from scheduled every 8 hours to as needed on postoperative day 1" — Rebecca Brown (clinical) [Ep 19 · 2:34](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=154)
- "The epidural catheter is stopped at 6 AM on postoperative day 2" — Rebecca Brown (clinical) [Ep 19 · 2:53](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=173)
- "The epidural is removed when the pain team rounds later in the morning of postoperative day 2" — Rebecca Brown (clinical) [Ep 19 · 2:57](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=177)
- "Patients are transitioned to all oral pain medications on postoperative day 2, including oxycodone, Valium, Robaxin, Motrin, and Tylenol" — Rebecca Brown (clinical) [Ep 19 · 3:01](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=181)
- "A two view chest X-ray is obtained on postoperative day 2 to evaluate bar location and to rule out pleural effusion or pneumothorax" — Rebecca Brown (clinical) [Ep 19 · 3:10](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=190)
- "Dressings are removed and the chest is washed daily starting on postoperative day 2" — Rebecca Brown (clinical) [Ep 19 · 3:19](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=199)
- "Patients are encouraged to ambulate at least 3 times in the halls starting postoperative day 2" — Rebecca Brown (clinical) [Ep 19 · 3:26](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=206)
- "PT and OT work with the patient on postoperative day 3 to help them walk up and down stairs, and sign off once able" — Rebecca Brown (clinical) [Ep 19 · 3:51](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=231)
- "Patients are discharged home on postoperative day 3 if pain is well controlled and they are tolerating oral intake" — Rebecca Brown (clinical) [Ep 19 · 4:27](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=267)
- "Since institution of the clinical care pathway 2 to 3 years ago, length of stay has been reduced from 4.5 days to 3 days" — Rebecca Brown (epidemiological) [Ep 19 · 4:46](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=286)
- "Patient satisfaction has increased since institution of the clinical care pathway" — Rebecca Brown (epidemiological) [Ep 19 · 4:46](https://library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=286)
- "The study was an observational perspective study conducted in Italy from 2013 to 2022." — Lizzie Lee (epidemiological) [Ep 45 · 0:13](https://library.globalcastmd.com/watch/pectus-bar-dislocation-comparison-between-three-different-stabilization-techniques-adopted-in-a-single-centre-9184?t=13)
- "The study included 468 patients around 15 years old." — Lizzie Lee (epidemiological) [Ep 45 · 0:13](https://library.globalcastmd.com/watch/pectus-bar-dislocation-comparison-between-three-different-stabilization-techniques-adopted-in-a-single-centre-9184?t=13)
- "Surgeons placed 733 bars total across the patient cohort." — Lizzie Lee (epidemiological) [Ep 45 · 0:23](https://library.globalcastmd.com/watch/pectus-bar-dislocation-comparison-between-three-different-stabilization-techniques-adopted-in-a-single-centre-9184?t=23)
- "Bar dislocation is defined as when a bar rotates more than 30 degrees out of place." — Lizzie Lee (clinical) [Ep 45 · 0:31](https://library.globalcastmd.com/watch/pectus-bar-dislocation-comparison-between-three-different-stabilization-techniques-adopted-in-a-single-centre-9184?t=31)
- "Bridge fixation was significantly more stable than single bar fixation." (clinical) [Ep 45 · 0:38](https://library.globalcastmd.com/watch/pectus-bar-dislocation-comparison-between-three-different-stabilization-techniques-adopted-in-a-single-centre-9184?t=38)
- "None of the patients with bridge fixation had dislocated bars." — Lizzie Lee (clinical) [Ep 45 · 0:43](https://library.globalcastmd.com/watch/pectus-bar-dislocation-comparison-between-three-different-stabilization-techniques-adopted-in-a-single-centre-9184?t=43)
- "Bridge fixation is the best technique for preventing bar dislocation in pectus excavatum patients." (opinion) [Ep 45 · 0:49](https://library.globalcastmd.com/watch/pectus-bar-dislocation-comparison-between-three-different-stabilization-techniques-adopted-in-a-single-centre-9184?t=49)
- "Study conducted in Italy from 2013 to 2022 on 468 patients around 15 years old with pectus excavatum" — Lizzie Lee (epidemiological) [Ep 54 · 1:03](https://library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=63)
- "Surgeons placed 733 bars total across the patient cohort" — Lizzie Lee (epidemiological) [Ep 54 · 1:13](https://library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=73)
- "Bar dislocation is defined as rotation more than 30 degrees out of place" — Lizzie Lee (clinical) [Ep 54 · 1:21](https://library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=81)
- "Bridge fixation was significantly more stable than single bar fixation" — Lizzie Lee (clinical) [Ep 54 · 1:28](https://library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=88)
- "None of the patients with bridge fixation had dislocated bars compared to those who underwent the single bar technique" — Lizzie Lee (clinical) [Ep 54 · 1:33](https://library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=93)
- "Bridge fixation is the best technique for preventing bar dislocation in pectus excavatum patients" — Lizzie Lee (clinical) [Ep 54 · 1:39](https://library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=99)
- "Machine learning model developed by University of Split researchers aims to accurately identify appendicitis while minimizing unnecessary surgery" — Carlos Colunga (clinical) [Ep 54 · 2:14](https://library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=134)
- "Model trained on data from 551 pediatric patients who underwent appendectomy using clinical, laboratory, and anthropometric information" — Carlos Colunga (epidemiological) [Ep 54 · 2:24](https://library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=144)
- "Best performing model achieved 99.7% sensitivity in identifying appendicitis cases" — Carlos Colunga (clinical) [Ep 54 · 2:37](https://library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=157)
- "Model specificity could potentially help reduce up to 17% of negative appendectomies in high risk patients" — Carlos Colunga (clinical) [Ep 54 · 2:37](https://library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=157)
- "Model can differentiate between complicated and uncomplicated appendicitis with high accuracy" — Carlos Colunga (clinical) [Ep 54 · 2:54](https://library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=174)
- "Model uses readily available clinical and lab data without requiring advanced imaging" — Carlos Colunga (clinical) [Ep 54 · 2:54](https://library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=174)
- "Multi-center retrospective study conducted in the US from 2018 to 2022 on pediatric choledocholithiasis" — Cecilia Gigena (epidemiological) [Ep 54 · 3:34](https://library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=214)
- "Study compared transcystic laparoscopic common bile duct exploration versus ERCP-first approach" — Cecilia Gigena (clinical) [Ep 54 · 3:34](https://library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=214)
- "Study included 252 patients total: 156 in transcystic laparoscopic CBD exploration group and 96 in ERCP-first group" — Cecilia Gigena (epidemiological) [Ep 54 · 3:53](https://library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=233)
- "Patients in transcystic laparoscopic CBD exploration group had significantly lower complication rates" — Cecilia Gigena (clinical) [Ep 54 · 4:02](https://library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=242)
- "Patients in transcystic laparoscopic CBD exploration group had lower length of stay" — Cecilia Gigena (clinical) [Ep 54 · 4:02](https://library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=242)
- "Attempting transcystic laparoscopic common bile duct exploration may benefit pediatric patients with choledocholithiasis" — Cecilia Gigena (opinion) [Ep 54 · 4:16](https://library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=256)
- "Pectus excavatum patients commonly present with easy fatigability with exertion, shortness of breath with exertion, and chest pain in the area of the depression, generally not at rest but with exertion" — Robert Kelly (clinical) [Ep 20 · 1:33](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=93)
- "Both Marfan syndrome and Ehlers-Danlos syndrome are problems for which pectus excavatum is a marker" — Robert Kelly (clinical) [Ep 20 · 2:55](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=175)
- "In a normal chest, ribs should move like the handle of a bucket (up and out) and the sternum should move like the handle of an old fashioned water pump (towards the ceiling and out)" — Robert Kelly (clinical) [Ep 20 · 4:04](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=244)
- "In pectus excavatum, the depressed area is frequently absolutely fixed or in younger patients may move paradoxically so the xyphoid pulls back towards the spine during deep inspiration" — Robert Kelly (clinical) [Ep 20 · 4:29](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=269)
- "In a series of more than 4000 patients evaluated for pectus excavatum, just over 25% had scoliosis" — Robert Kelly (epidemiological) [Ep 20 · 6:05](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=365)
- "In the multi-center study of pectus excavatum at 11 centers, roughly two-thirds of patients had symptoms of fatigue, dyspnea, or chest pain" — Robert Kelly (epidemiological) [Ep 20 · 8:39](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=519)
- "The Haller index is the ratio of the inner transverse diameter divided by the distance between the back of the sternum and the front of the spine, with an index greater than 3.25 indicating severe pectus" — Robert Kelly (clinical) [Ep 20 · 9:44](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=584)
- "In patients with barrel chest, the Haller index underestimates the depth of depression because the AP diameter is increased" — Robert Kelly (clinical) [Ep 20 · 10:09](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=609)
- "The Kansas City group advocates an index showing if there is more than a 10% drop in the AP diameter at the depression compared to laterally, this should be considered as a reason to operate" — Robert Kelly (guideline) [Ep 20 · 10:24](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=624)
- "Mitral valve prolapse is present in about 14% of pectus excavatum patients, compared to 1% in young patients generally" — Robert Kelly (epidemiological) [Ep 20 · 12:53](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=773)
- "On average in a large number of patients, pulmonary function tests will be down by about one standard deviation from average (85-90% predicted)" — Robert Kelly (clinical) [Ep 20 · 13:37](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=817)
- "In the multi-center study, patients came up by close to a standard deviation in pulmonary function when they had the bellows action of the chest restored" — Robert Kelly (clinical) [Ep 20 · 14:15](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=855)
- "Restrictive lung disease is defined as an FVC less than 80% predicted with a normal FEV1/FVC ratio, and this restrictive process is corrected by pectus operation unlike asthma" — Robert Kelly (clinical) [Ep 20 · 14:40](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=880)
- "Patients with worse pectus have more likelihood of having restrictive pulmonary problems" — Robert Kelly (clinical) [Ep 20 · 15:05](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=905)
- "Surgical indications require at least 3 of 6 criteria: Haller index >3.2, PFTs <80% predicted, cardiac abnormalities on echo, symptoms, progressive pectus, or major psychosocial issues" — Robert Kelly (guideline) [Ep 20 · 15:11](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=911)
- "Around the time of the teenage growth spurt, there are a lot of kids in whom the pectus gets a lot deeper" — Robert Kelly (clinical) [Ep 20 · 15:35](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=935)
- "The ideal age for surgery is sometime just prior to the onset of puberty or early in puberty: ages 11-13 for girls and a year or two older for boys" — Robert Kelly (guideline) [Ep 20 · 16:47](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1007)
- "Having the bar in place during the rapid growth spurt of puberty results in extremely low likelihood of recurrence" — Robert Kelly (clinical) [Ep 20 · 17:02](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1022)
- "Some Asian groups operate on patients when they are quite young, well under 10 years old, and report good results" — Robert Kelly (clinical) [Ep 20 · 17:29](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1049)
- "The Allergies test developed in Canada includes all components of the stainless steel bar, and patients have reacted against a number of minor components including nickel, chromium, and cobalt" — Robert Kelly (clinical) [Ep 20 · 21:40](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1300)
- "Titanium bars must be bent at the factory and ordered in advance, and are much more expensive than stainless steel bars" — Robert Kelly (clinical) [Ep 20 · 22:17](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1337)
- "The likelihood of transfusion in Nuss procedure is exceedingly low" — Robert Kelly (clinical) [Ep 20 · 22:45](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1365)
- "Bar length is measured from mid-axillary line to mid-axillary line and subtracting an inch" — Robert Kelly (clinical) [Ep 20 · 23:29](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1409)
- "It should be standard practice in patients with any difficulty in visualization to use some technique of sternal elevation during Nuss procedure" — Robert Kelly (guideline) [Ep 20 · 24:43](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1483)
- "The most important part of the Nuss procedure is that you see the tip of the introducer at all times when passing from one side to the other" — Robert Kelly (clinical) [Ep 20 · 26:02](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1562)
- "The bar should be placed medial to the pectus ridge so there is a rib providing counterforce, as placing it very laterally results in only intercostal muscles preventing movement and they will strip or rip" — Robert Kelly (clinical) [Ep 20 · 28:54](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1734)
- "In patients who are growing, stabilizers on both sides can cause a wasp waist effect, so they are generally placed on only one side of the bar" — Robert Kelly (clinical) [Ep 20 · 30:07](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1807)
- "If a patient is over approximately 6 feet 2 inches tall, the chances of needing two bars are almost 100%" — Robert Kelly (clinical) [Ep 20 · 30:39](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1839)
- "In the series of past 2000 Nuss procedures, about 2.7% of patients required some sort of revision for bar displacement" — Robert Kelly (epidemiological) [Ep 20 · 33:14](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1994)
- "The incidence of bar displacement has been cut to about half by using stabilizers and wrapping around the crossing of the bar to the rib with pericostal sutures" — Robert Kelly (clinical) [Ep 20 · 33:28](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2008)
- "Bar allergy occurred in 0.9% of patients, and screening for metal allergy has been performed since 2004, dramatically decreasing the incidence" — Robert Kelly (epidemiological) [Ep 20 · 34:13](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2053)
- "About 6.4% of patients had clinical or patch test evidence of metal allergy" — Robert Kelly (epidemiological) [Ep 20 · 34:27](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2067)
- "Wound infection occurred in 2.3% of patients, with more than two-thirds being superficial or cellulitis" — Robert Kelly (epidemiological) [Ep 20 · 34:40](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2080)
- "Recurrence occurred in about 1.2% of patients" — Robert Kelly (epidemiological) [Ep 20 · 35:07](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2107)
- "The bar should remain in place for at least 2 years, with preference for closer to 3 years rather than 2 years" — Robert Kelly (guideline) [Ep 20 · 36:47](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2207)
- "A study from Saint Etienne, France found vacuum bell treatment effective in eliminating pectus excavatum in 23 of 73 patients" — Robert Kelly (clinical) [Ep 20 · 37:19](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2239)
- "In patients who are young, under 10 years old, the vacuum bell can be very effective in lifting the chest up" — Robert Kelly (clinical) [Ep 20 · 37:58](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2278)
- "A Nuss procedure after a recurrent pectus excavatum following previous Ravitch operation will elevate the chest but won't restore movement of the chest wall, and patients will have restrictive process from scarring" — Robert Kelly (clinical) [Ep 20 · 39:06](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2346)
- "Brace therapy for pectus carinatum is successful in somewhere between two-thirds and three-quarters of patients" — Robert Kelly (clinical) [Ep 20 · 40:04](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2404)
- "There is a broad perception among surgeons who have done many Ravitch operations for carinatum that there is an extremely low recurrence rate, as opposed to the 10% recurrence rate after excavatum Ravitch" — Robert Kelly (opinion) [Ep 20 · 43:43](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2623)
- "There is a family tendency in pectus in approximately 40% of patients, but the majority do not have a family history" — Robert Kelly (epidemiological) [Ep 20 · 44:52](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2692)
- "Pectus excavatum is the most common chest wall deformity, though Argentina reports carinatum as more common in their country" (epidemiological) [Ep 1 · 2:19](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=139)
- "Pectus excavatum is rarely seen in African Americans" (epidemiological) [Ep 1 · 2:31](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=151)
- "Pectus excavatum is more often in males than females and statistically appears more in tall, thin white boys" (epidemiological) [Ep 1 · 2:57](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=177)
- "Females with pectus have a slightly increased risk of mild scoliosis, occurring in 18% of those with pectus" (epidemiological) [Ep 1 · 3:11](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=191)
- "Many patients with pectus have connective tissue disorders higher than normal population, such as Marfan syndrome and Ehlers-Danlos syndrome" (clinical) [Ep 1 · 3:26](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=206)
- "Studies show varying degrees of cardiac and pulmonary compromise in pectus excavatum that worsen as patients grow and chest wall becomes less compliant" (clinical) [Ep 1 · 4:08](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=248)
- "Deep pectus defects can cause decreased cardiac output with heart displacement, leading to patients tiring quicker than peers despite starting out running fine" (clinical) [Ep 1 · 4:22](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=262)
- "Pectus excavatum can cause pulmonary effects resembling restrictive lung disease with atelectasis if sufficiently restricted" (clinical) [Ep 1 · 4:43](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=283)
- "In Maryland, insurance typically covers pectus repair when Haller index is greater than 3.25" (guideline) [Ep 1 · 5:12](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=312)
- "Johns Hopkins developed a pectus excavatum CT protocol using flash scan with fewer cuts at deeper depth to reduce radiation exposure" (clinical) [Ep 1 · 6:17](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=377)
- "Pectus severity index can be accurately measured with just PA and lateral chest X-ray without need for CT scan" (clinical) [Ep 1 · 6:58](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=418)
- "Exercise pulmonary function testing often shows patients in fairly normal range, but slight drops can be seen, with more restriction in severe cases" (clinical) [Ep 1 · 7:55](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=475)
- "Some patients with severe psychological symptoms about their pectus may not be satisfied with surgical outcome no matter how good the chest result, requiring preoperative counseling about realistic expectations" (opinion) [Ep 1 · 8:41](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=521)
- "The Nuss minimally invasive operation began in 1988, placing stainless steel rod underneath chest wall to elevate it, avoiding interruption of growth plates" (clinical) [Ep 1 · 11:36](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=696)
- "Pectus bars are usually kept in place for 2 to 3 years, with longer duration (closer to 3 years) associated with decreased recurrence rates, especially in younger patients" (clinical) [Ep 1 · 12:24](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=744)
- "Average age for pectus excavatum surgery is about 14 years" (epidemiological) [Ep 1 · 12:56](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=776)
- "Vacuum bell therapy requires younger patients or those without stiff chest wall to be effective in pulling up the sternum" (clinical) [Ep 1 · 14:02](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=842)
- "Nuss and colleagues in Virginia use vacuum bell intraoperatively to pull up deep pectus chest wall to facilitate safer bar passage" (clinical) [Ep 1 · 14:23](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=863)
- "UCSF and Shriners have begun magnetic mini-mover trial using internal and external magnets to create force field over several months to elevate pectus in 8-14 year olds" (clinical) [Ep 1 · 15:48](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=948)
- "Magnetic therapy for pectus is quite effective according to preliminary results" (opinion) [Ep 1 · 17:01](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1021)
- "Johns Hopkins performs concurrent pectus and cardiac surgery in patients with Marfan syndrome and cardiac issues to avoid two separate operations" (clinical) [Ep 1 · 18:28](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1108)
- "Pectus carinatum patients complain of tenderness at the protrusion, especially if they play sports with pads or sleep on their stomach" (clinical) [Ep 1 · 19:34](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1174)
- "Bracing has become standard of care for pectus carinatum, moving away from surgical treatment" (guideline) [Ep 1 · 20:02](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1202)
- "Pectus carinatum braces typically require 23 hours per day wear initially, then weaning to nighttime only, for about 9-12 months total" (clinical) [Ep 1 · 21:52](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1312)
- "The dynamic compression device from Argentina (Marcelo Martinez Ferro's brace) is emerging as the best brace for pectus carinatum" (opinion) [Ep 1 · 23:04](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1384)
- "Physical therapist application of pectus carinatum brace with chest massage and defect manipulation before tightening produces better compliance and results than orthotist application" (clinical) [Ep 1 · 25:45](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1545)
- "Pectus carinatum minimally invasive repair (Abramson technique or reverse Nuss) has shown wire eroding through bone due to force" (clinical) [Ep 1 · 26:35](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1595)
- "Cantrell's pentalogy can have high mortality depending on extent of defects" (clinical) [Ep 1 · 28:39](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1719)
- "Poland syndrome patients are typically sent to plastic surgery at young age for syndactyly and other hand issues, with chest wall repair delayed until near completion of growth" (clinical) [Ep 1 · 29:18](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1758)
- "Pain from Nuss repair is reportedly more than Ravitch repair despite less incision" (clinical) [Ep 1 · 31:17](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1877)
- "PCA provides better pain control than epidurals for pectus repair, as epidurals delayed early ambulation and did not cover pain adequately" (clinical) [Ep 1 · 31:39](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1899)
- "Johns Hopkins gets pectus patients out of bed the night of surgery to ambulate to bathroom without Foley catheters" (clinical) [Ep 1 · 32:00](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1920)
- "Typical pectus excavatum hospital discharge is by day 3 or 4 postoperatively" (clinical) [Ep 1 · 32:33](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1953)
- "Patients who are in better physical condition, play sports, stretch, and do upper body work fare better with pectus surgery and recover faster" (clinical) [Ep 1 · 36:11](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=2171)
- "Most pectus patients are off narcotics between 2 and 4 weeks postoperatively" (clinical) [Ep 1 · 42:20](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=2540)
- "Benzodiazepines and anxiolytics are valuable in pectus patients as anxiety is a large component of pain experience" (opinion) [Ep 1 · 43:15](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=2595)
- "Contact sports are allowed after 6 weeks post-pectus repair with gradual return, though there is risk of bar migration" (clinical) [Ep 1 · 43:43](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=2623)
- "Compliance rate with pectus carinatum bracing is approximately 85%" (epidemiological) [Ep 1 · 45:17](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=2717)
- "Haller index of 3.25 was established retrospectively by Alec Haller in the 1980s based on cases he fixed versus those he did not" — Holcomb (clinical) [Ep 2 · 4:33](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=273)
- "Psychosocial well-being justifies repair of severe pectus excavatum regardless of physical symptoms" — Holcomb (opinion) [Ep 2 · 1:59](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=119)
- "Insurance companies require documented symptoms and Haller index for approval" (guideline) [Ep 2 · 2:13](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=133)
- "Nickel allergy occurs in 2.8% of pectus patients in the Norfolk series" — Holcomb (epidemiological) [Ep 2 · 24:18](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1458)
- "Epidural catheters were removed within 24 hours or could not be placed in almost 25% of patients in a randomized trial" — Holcomb (clinical) [Ep 2 · 18:18](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1098)
- "Epidural group had longer OR time due to catheter placement" — Holcomb (clinical) [Ep 2 · 17:44](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1064)
- "Pain scores favored epidural for first 2 days, were flat on day 3, then favored PCA on later days" — Holcomb (clinical) [Ep 2 · 18:04](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1084)
- "Six infections occurred in 168 patients over 6 years (3.6% rate)" — Holcomb (epidemiological) [Ep 2 · 19:56](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1196)
- "Five of six infections required incision and drainage" — Holcomb (clinical) [Ep 2 · 20:18](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1218)
- "Three of six infections developed recurrent infections" — Holcomb (clinical) [Ep 2 · 20:18](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1218)
- "One patient with recurrent infection required early bar removal" — Holcomb (clinical) [Ep 2 · 20:23](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1223)
- "Nuss group found better results when bar left in at least 24 months" — Holcomb (clinical) [Ep 2 · 24:35](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1475)
- "Doctor Nuss personally recommends leaving bars in for 3 years" — Holcomb (opinion) [Ep 2 · 25:03](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1503)
- "Kansas City series: 503 pectus excavatum repairs with subxiphoid technique" — Holcomb (epidemiological) [Ep 2 · 25:36](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1536)
- "Kansas City series: 5% required two bars" — Holcomb (epidemiological) [Ep 2 · 25:55](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1555)
- "Kansas City series: 4% infection rate" — Holcomb (epidemiological) [Ep 2 · 25:58](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1558)
- "Kansas City series: 1.5% bar dislodgement or stabilizer discomfort requiring removal, mostly early in experience" — Holcomb (epidemiological) [Ep 2 · 26:14](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1574)
- "Kansas City series: 4 patients had bar rotation, early in experience" — Holcomb (epidemiological) [Ep 2 · 26:31](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1591)
- "Kansas City series: 2 of 300 patients required chest tube" — Holcomb (epidemiological) [Ep 2 · 26:38](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1598)
- "Kansas City series: no recurrences requiring reoperation" — Holcomb (epidemiological) [Ep 2 · 26:43](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1603)
- "Kansas City series: no cardiac injuries" — Holcomb (epidemiological) [Ep 2 · 26:43](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1603)
- "Kansas City series: mean hospitalization 4 days" — Holcomb (epidemiological) [Ep 2 · 26:43](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1603)
- "Approximately 14-15 cardiac injuries with Nuss procedure reported worldwide" — Holcomb (epidemiological) [Ep 2 · 11:13](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=673)
- "Dynamic compression brace requires less than 7.5 PSI to correct pectus carinatum for successful bracing" — Holcomb (clinical) [Ep 2 · 30:17](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1817)
- "Dynamic compression brace worn 6-20 months, then retainer mode 6-12 hours daily" — Holcomb (clinical) [Ep 2 · 30:49](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1849)
- "Kansas City has braced 200 pectus carinatum patients with dynamic compression device" — Holcomb (epidemiological) [Ep 2 · 33:17](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1997)
- "Kansas City has performed one or two open carinatum repairs since starting bracing 4 years ago" — Holcomb (epidemiological) [Ep 2 · 34:20](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=2060)
- "Dynamic compression brace costs approximately $1500-2000 total (kit plus device)" — Holcomb (clinical) [Ep 2 · 33:49](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=2029)
- "Thoracoscopy is not helpful for cardiac injury prevention in Kansas City's experience" — Holcomb (opinion) [Ep 2 · 13:11](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=791)
- "Subxiphoid finger-guided technique is the safest way to avoid cardiac injury in Kansas City's experience" — Holcomb (opinion) [Ep 2 · 14:08](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=848)
- "Passing bar left-to-right may be safer than right-to-left because heart is encountered first" (opinion) [Ep 2 · 12:29](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=749)
- "Transesophageal echo can identify adhesions between heart and sternum in redo cases" (clinical) [Ep 2 · 15:29](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=929)
- "Bone hook through subxiphoid incision can lift sternum an additional 1-2 millimeters" (clinical) [Ep 2 · 15:54](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=954)
- "Vacuum suction device is used in Germany but not FDA-approved in the United States" — Holcomb (clinical) [Ep 2 · 16:27](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=987)
- "Magnetic mini-mover procedure (3MP) is in 18-month FDA trial with all patients implanted" — Holcomb (clinical) [Ep 2 · 27:29](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1649)
- "Chondrogladiolar carinatum is the most common subtype" — Holcomb (epidemiological) [Ep 2 · 28:54](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1734)
- "Carinatum-Silverman syndrome shows comma deformity on lateral X-ray" — Holcomb (clinical) [Ep 2 · 31:29](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1889)
- "99% of pectus patients receive transthoracic echos reported as normal with no issues" — Dawn Jaroszewski (clinical) [Ep 4 · 2:55](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=175)
- "Transthoracic echo windows are difficult for visualizing the right side of the heart in pectus patients" — Dawn Jaroszewski (clinical) [Ep 4 · 3:03](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=183)
- "Intraoperative TEE shows nearly triple the velocity or volume going through the right ventricular outflow tract post-repair" — Dawn Jaroszewski (clinical) [Ep 4 · 3:39](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=219)
- "Left ventricular output improves significantly when right ventricular flow increases, because the heart functions as a pump" — Dawn Jaroszewski (clinical) [Ep 4 · 3:54](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=234)
- "In older pectus patients, cardiac output can improve from 55% (normal range) to 77% after repair" — Dawn Jaroszewski (clinical) [Ep 4 · 4:30](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=270)
- "Heart contractility, synchrony, and mobility show significant differences between pre-op and post-op in pectus patients" — Dawn Jaroszewski (clinical) [Ep 4 · 4:57](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=297)
- "In 168 patients studied pre and post-op, the minimally invasive repair group had a 30% increase in cardiac output" — Dawn Jaroszewski (clinical) [Ep 4 · 5:28](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=328)
- "Overall cardiac output increase across all pectus repair patients was 24%" — Dawn Jaroszewski (clinical) [Ep 4 · 5:55](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=355)
- "Open repair group shows less cardiac output improvement than minimally invasive group, likely because open cases include mixed pathology like malunion" — Dawn Jaroszewski (clinical) [Ep 4 · 5:28](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=328)
- "Standard Bruce protocol ischemic stress testing is not the appropriate test for pectus patients unless ischemia is suspected" — Dawn Jaroszewski (clinical) [Ep 4 · 6:24](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=384)
- "Cardiopulmonary exercise testing separates cardiac pump efficiency from pulmonary component, making it ideal for pectus evaluation" — Dawn Jaroszewski (clinical) [Ep 4 · 6:45](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=405)
- "VO2 max and anaerobic VO2 are very abnormal in pectus patients while other parameters remain normal" — Dawn Jaroszewski (clinical) [Ep 4 · 6:58](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=418)
- "A French study of 125 adults showed VO2 parameters statistically improve and normalize after surgical pectus repair" — Dawn Jaroszewski (clinical) [Ep 4 · 7:19](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=439)
- "Pectus patients show limited ability to increase stroke volume; output initially increases by heart rate but plateaus when volume increase is needed due to chest cage restriction" — Dawn Jaroszewski (clinical) [Ep 4 · 7:33](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=453)
- "Pectus patients show a flat line on exercise testing where normal patients have an upward slope that peaks at maximum" — Dawn Jaroszewski (clinical) [Ep 4 · 7:50](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=470)
- "Ehlers-Danlos type 4 involves internal tissue fragility requiring specially managed repairs" (clinical) [Ep 4 · 10:52](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=652)
- "Pectus excavatum is not typically associated with Ehlers-Danlos type 4, which is not primarily a skeletal or hypermobile disorder" (clinical) [Ep 4 · 10:31](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=631)
- "Visible veins or family history of abdominal aortic aneurysm do not indicate Ehlers-Danlos vascular type" (clinical) [Ep 4 · 11:40](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=700)
- "Younger patients tolerate pectus repair better due to chest wall flexibility; young children can be repaired with minimal hardware" — Dawn Jaroszewski (clinical) [Ep 4 · 16:22](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=982)
- "Adults have tremendous pain from pectus repair because their chest walls are rigid" — Dawn Jaroszewski (clinical) [Ep 4 · 16:32](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=992)
- "In Korea, pectus repairs are performed on 3-4-5 year olds using very small bar sets" — Dawn Jaroszewski (clinical) [Ep 4 · 16:37](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=997)
- "The trend in the United States has moved from repairing pectus patients young to repairing older populations" — Dawn Jaroszewski (epidemiological) [Ep 4 · 16:49](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=1009)
- "Donald Nuss initially performed pectus repairs on very young patients, as young as 3 years of age, without high recurrence rates in early series" (clinical) [Ep 4 · 17:12](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=1032)
- "The Nuss institution has moved away from operating on young children despite early series results" — Dawn Jaroszewski (opinion) [Ep 4 · 18:08](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=1088)
- "Vacuum bell works if the patient has a very flexible chest and wears it religiously" — Dawn Jaroszewski (clinical) [Ep 4 · 19:23](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=1163)
- "Patient compliance with vacuum bell varies greatly, making it difficult to assess true value" — Dawn Jaroszewski (clinical) [Ep 4 · 19:34](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=1174)
- "There are no randomized controlled trials separating pectus patients who received surgery from those who did not" — Dawn Jaroszewski (epidemiological) [Ep 4 · 21:02](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=1262)
- "95% of patients presenting to Jaroszewski's clinic are seeking surgery" — Dawn Jaroszewski (epidemiological) [Ep 4 · 21:56](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=1316)
- "Older pectus patients report progressive worsening of exercise tolerance and breathing over the last decade" — Dawn Jaroszewski (clinical) [Ep 4 · 1:30](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=90)
- "Insurance companies in the US are reluctant to pay for post-operative cardiopulmonary exercise testing" — Dawn Jaroszewski (epidemiological) [Ep 4 · 7:10](https://library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=430)
- "Cincinnati Children's is the only pediatric hospital with an inpatient integrative care team consisting of about 15 holistic health specialists" (clinical) [Ep 6 · 0:04](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=4)
- "Primary modalities used with pectus repair patients are massage therapy, which can reduce pain and anxiety" (clinical) [Ep 6 · 0:34](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=34)
- "Massage therapy decreases cortisol levels and enhances relaxation according to research from the Tiffany Fields Research Institute" (clinical) [Ep 6 · 1:00](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=60)
- "Energy therapies (Reiki and healing touch) are biofield therapies that work to restore harmony and balance within the body" (clinical) [Ep 6 · 1:31](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=91)
- "Energy therapies can be hands-on or hands-off and are used extensively in PACU for patients coming out of anesthesia" (clinical) [Ep 6 · 1:57](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=117)
- "Most inpatient pediatric patients experience pain or discomfort during hospitalization" (epidemiological) [Ep 6 · 2:24](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=144)
- "A 2009 retrospective database review of 519 patients showed massage therapy and healing touch reduced pain and anxiety scores by 50% in 50% of patients" (clinical) [Ep 6 · 3:01](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=181)
- "Teaching mindfulness and meditation is difficult when patients are already under high stress and pain levels" (opinion) [Ep 6 · 3:41](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=221)
- "Physical therapy attends the pectus education class prior to surgery to set expectations" — Jim (clinical) [Ep 6 · 5:22](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=322)
- "Early mobility helps reduce the rate of complications and decrease overall length of stay according to multiple studies" — Jim (clinical) [Ep 6 · 5:44](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=344)
- "Pectus repair patients have precautions including no bending, twisting, or rolling" — Jim (clinical) [Ep 6 · 6:23](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=383)
- "Patients are taught a crunch-to-sit-up technique, swinging legs over the bed without using arms to push or pull" — Jim (clinical) [Ep 6 · 6:27](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=387)
- "Occupational therapy provides techniques for dressing and bathing within precautions and may provide equipment like long-handled sponges and reachers" — Jim (clinical) [Ep 6 · 6:41](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=401)
- "Mary Mastery, a PT in Illinois, is conducting research on increasing joint mobility, muscle strength, balance, and motor planning pre and post pectus surgery" — Jim (clinical) [Ep 6 · 7:26](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=446)
- "A preoperative pectus education class was created about 3 years ago to decrease anxiety and prevent patients from feeling overwhelmed" (clinical) [Ep 6 · 8:47](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=527)
- "The preoperative class is multidisciplinary including pain service, prior patients, and physical therapy" (clinical) [Ep 6 · 9:05](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=545)
- "All patients and families are required to attend the preoperative class before scheduled surgery" — Emily (clinical) [Ep 6 · 9:24](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=564)
- "The class covers preoperative testing requirements, expected hospital stay, recovery room expectations, epidural placement, and postoperative devices like compression boots and Foley catheters" — Emily (clinical) [Ep 6 · 9:30](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=570)
- "The class includes discussion of three months of postoperative restrictions" (clinical) [Ep 6 · 10:09](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=609)
- "The SSI bundle for pectus population has been in place for almost 3 years and was developed through literature review and collaboration with infectious disease" (clinical) [Ep 6 · 11:20](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=680)
- "All patients are screened for metal allergy with patch testing and for MRSA and staph, with positive patients treated with Bactroban" (clinical) [Ep 6 · 11:45](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=705)
- "Appropriate intraoperative and postoperative antibiotics are ordered for all pectus patients" (clinical) [Ep 6 · 11:59](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=719)
- "Ehlers-Danlos syndrome presents with multiple problems including chronic pain, chronic headaches, irritable bowel syndrome, panic and anxiety disorders, and sleep dysfunction" — Derek (clinical) [Ep 6 · 12:51](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=771)
- "Ehlers-Danlos can be divided into three parts: musculoskeletal problem, autonomic dysfunction, and GI dysfunction" — Derek (clinical) [Ep 6 · 13:20](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=800)
- "Most pain in Ehlers-Danlos patients is muscle-based or from muscle attachments rather than arthritis or bone pain" — Derek (clinical) [Ep 6 · 13:50](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=830)
- "Physical therapy for Ehlers-Danlos focuses on loosening tight muscles and strengthening counterbalancing weak muscles to provide joint stability" — Derek (clinical) [Ep 6 · 14:02](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=842)
- "Ehlers-Danlos patients have impaired proprioception with more movement than appropriate, demonstrated in multiple studies and meta-analyses" — Derek (clinical) [Ep 6 · 14:21](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=861)
- "70% of adult Ehlers-Danlos patients have blacking out sensation or dizziness with standing associated with racing heartbeat" — Derek (epidemiological) [Ep 6 · 14:49](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=889)
- "Ehlers-Danlos patients with POTS phenotype have overactivity of the sympathetic nervous system" — Derek (clinical) [Ep 6 · 15:33](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=933)
- "Sympathetic nervous system overactivity causes patients to be more panicky and anxious, creates vigilant state causing difficulty falling asleep and easy waking, resulting in terrible sleep and chronic fatigue" — Derek (clinical) [Ep 6 · 15:45](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=945)
- "Irritable bowel syndrome in Ehlers-Danlos occurs because sympathetic activation shuts down parasympathetic digestive functions, causing nausea or abdominal pain immediately after eating" — Derek (clinical) [Ep 6 · 16:06](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=966)
- "The working model is that sense of tension in the cardiovascular system is impaired in Ehlers-Danlos, affecting blood pressure feedback and catecholamine regulation" — Derek (clinical) [Ep 6 · 16:23](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=983)
- "Many Ehlers-Danlos patients become deconditioned due to leg pain, chronic fatigue, and other problems, resulting in poor cardiac output" — Derek (clinical) [Ep 6 · 17:03](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=1023)
- "Exercise programs improve multiple systems in Ehlers-Danlos patients, contrary to the intuitive approach of telling them to slow down" — Derek (opinion) [Ep 6 · 17:17](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=1037)
- "Dallas-developed protocol for dysautonomia treatment requires 5 days per week, 30 minutes per day of exercise reaching 80% of maximum heart rate" — Derek (guideline) [Ep 6 · 17:39](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=1059)
- "Ehlers-Danlos patients with dizziness on standing cannot tolerate treadmill exercise as it causes instant dizziness, heart rate up to 220, and nausea" — Derek (clinical) [Ep 6 · 17:58](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=1078)
- "Recumbent exercise (bike or rowing machine) or pool-based exercise works better for Ehlers-Danlos patients because blood doesn't pool in feet" — Derek (clinical) [Ep 6 · 18:13](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=1093)
- "Aquatic-based therapies support blood flow to the brain in Ehlers-Danlos patients" — Derek (clinical) [Ep 6 · 18:33](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=1113)
- "Exercise protocols have shown changes in chronic fatigue, sleep dysfunction, and pain sensitivity in Ehlers-Danlos patients" — Derek (clinical) [Ep 6 · 18:43](https://library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=1123)
- "Marfan syndrome skeletal evaluation includes examination for wrist sign (thumb and pinky finger overlap when wrapped around wrist) and thumb protrusion past ulnar border" — Derek (clinical) [Ep 7 · 0:21](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=21)
- "Skeletal findings in Marfan syndrome evaluate for overgrowth of long bones in relationship to trunk, contributing to patients being tall with longer legs and arms relative to body" — Derek (clinical) [Ep 7 · 0:39](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=39)
- "Marfan syndrome evaluation includes arm span to height ratios and upper to lower segment ratios" — Derek (clinical) [Ep 7 · 1:00](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=60)
- "Additional skeletal findings in Marfan syndrome include pectus excavatum, pectus carinatum, scoliosis, and hind foot deformities" — Derek (clinical) [Ep 7 · 1:07](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=67)
- "Cardiac risk associated with Marfan syndrome includes aortic dissection and mitral valve prolapse" — Derek (clinical) [Ep 7 · 1:19](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=79)
- "Marfan syndrome complications can include retinal detachments" — Derek (clinical) [Ep 7 · 1:19](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=79)
- "Marfan syndrome diagnosis is largely centered on cardiac findings, with echocardiogram or MRI as main tools to evaluate for dilated aortic root" — Derek (clinical) [Ep 7 · 1:38](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=98)
- "Lens dislocations are evaluated in Marfan syndrome workup" — Derek (clinical) [Ep 7 · 1:55](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=115)
- "In cases with suggestive findings, testing of the fibrillin gene can be performed for Marfan syndrome" — Derek (clinical) [Ep 7 · 1:55](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=115)
- "Patients with Marfan-like characteristics may warrant evaluation for other genetic syndromes related to TGF beta signaling, which may contribute to aortic remodeling and long bone overgrowth" — Derek (clinical) [Ep 7 · 2:05](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=125)
- "Ehlers-Danlos syndrome is by far the more common condition evaluated in pectus patients compared to Marfan syndrome" — Derek (epidemiological) [Ep 7 · 2:27](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=147)
- "Ehlers-Danlos syndrome represents a grouping of related conditions involving connective tissue, not a single condition" — Derek (clinical) [Ep 7 · 2:45](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=165)
- "Classic type Ehlers-Danlos is due to defects in collagen 5 and characterized by joint hypermobility and abnormal skin that is fragile, thin, with weak papery thin scars" — Derek (clinical) [Ep 7 · 3:00](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=180)
- "Vascular type Ehlers-Danlos is caused by mutations in collagen 3" — Derek (clinical) [Ep 7 · 3:17](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=197)
- "Vascular type Ehlers-Danlos is one of the least common conditions seen in pectus clinic" — Derek (epidemiological) [Ep 7 · 3:39](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=219)
- "Vascular type Ehlers-Danlos is characterized by internal organ fragility rather than hypermobile joints" — Derek (clinical) [Ep 7 · 3:45](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=225)
- "Vascular type Ehlers-Danlos evaluation looks for family or personal history of ruptures: bowel rupture, aortic rupture, or uterus rupture" — Derek (clinical) [Ep 7 · 3:52](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=232)
- "Genetic testing for vascular type Ehlers-Danlos is 99% sensitive" — Derek (clinical) [Ep 7 · 4:07](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=247)
- "Hypermobile type Ehlers-Danlos is typically what is being evaluated in pectus clinic" — Derek (clinical) [Ep 7 · 4:23](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=263)
- "Beighton score is a test of 9 different joints, scored 1 for each side except the hips" — Derek (clinical) [Ep 7 · 4:41](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=281)
- "Beighton score criteria include: hyperextension of arms past 10 degrees, hyperextension of pinky past 90 degrees, apposition of thumb to forearm, hyperextension of knee past 10 degrees (all scored bilaterally for 8 points), and placing hands flat on floor without bending knees (assessing hip hypermobility)" — Derek (clinical) [Ep 7 · 4:52](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=292)
- "A person with 5 or more hypermobile joints on Beighton score meets criteria for generalized hypermobility" — Derek (clinical) [Ep 7 · 5:27](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=327)
- "Additional findings for hypermobile EDS include mild skin changes (mild hyperextensibility, easy bruising), scarring abnormalities, striae, and family history of hypermobility" — Derek (clinical) [Ep 7 · 5:35](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=335)
- "The dividing line between being flexible and having Ehlers-Danlos may be very fuzzy" — Derek (opinion) [Ep 7 · 6:01](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=361)
- "Distinction between flexibility and EDS is based on presence of similar findings in family members and presence of problems" — Derek (clinical) [Ep 7 · 6:17](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=377)
- "Common problems in hypermobile EDS include joints that are loose and dislocate" — Derek (clinical) [Ep 7 · 6:25](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=385)
- "Hypermobile EDS patients exhibit a constellation of findings including chronic pain, chronic headaches and migraines, temporomandibular joint dysfunction, easy bruising and bleeding, orthostatic hypotension or dizziness or blacking out with standing with racing heartbeat, chronic constipation with irritable bowel syndrome, panic and anxiety disorders, and sleeping problems" — Derek (clinical) [Ep 7 · 6:32](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=392)
- "Most adult hypermobile EDS patients have almost all of the associated constellation of problems" — Derek (clinical) [Ep 7 · 7:12](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=432)
- "In children with hypermobile EDS, problems may be very mild or not evident, but may begin to emerge during puberty, which may coincide with when they consider pectus surgery" — Derek (clinical) [Ep 7 · 7:17](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=437)
- "The chronic pain aspect of hypermobile EDS can play into whether patients are at risk for more pain from pectus surgery" — Derek (clinical) [Ep 7 · 7:33](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=453)
- "Hypermobility is a risk factor for fibromyalgia" — Derek (clinical) [Ep 7 · 7:42](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=462)
- "50% of teenagers diagnosed with fibromyalgia have hypermobility" — Derek (epidemiological) [Ep 7 · 7:42](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=462)
- "Fibromyalgia involves central sensitivity to pain, meaning patients are unable to filter out unwanted pain signals in the same way as other persons" — Derek (clinical) [Ep 7 · 7:56](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=476)
- "Hypermobile patients may be at risk for having more problems with chronic pain" — Derek (clinical) [Ep 7 · 8:08](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=488)
- "Pectus excavatum repair is arguably the most painful operation that could be done in a child" — Victor Garcia (opinion) [Ep 5 · 2:48](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=168)
- "Approximately 15% of pectus patients had right ventricular ejection fractions less than 50% (normal is 50%)" — Michael Taylor (clinical) [Ep 5 · 21:30](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1290)
- "Patients with RV compression had depressed right ventricular ejection fractions" — Michael Taylor (clinical) [Ep 5 · 23:25](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1405)
- "Patients with compression of the RV free wall versus the RA-RV groove had more decreased RV function" — Michael Taylor (clinical) [Ep 5 · 23:30](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1410)
- "Kids can have RV ejection fractions in the 40s and be asymptomatic" — Michael Taylor (clinical) [Ep 5 · 24:31](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1471)
- "The Haller index can be normal in patients with obvious pectus deformity due to barrel-shaped chest configuration" — Eric Crotty (clinical) [Ep 5 · 14:50](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=890)
- "The correction index greater than 10% shows no overlap between normal and abnormal patients" — Eric Crotty (clinical) [Ep 5 · 13:57](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=837)
- "Depression index greater than 0.2 is the cutoff between normal and abnormal patients" — Eric Crotty (clinical) [Ep 5 · 14:11](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=851)
- "Haller's 3.25 cutoff was from an observational retrospective study, not a rigorous scientific prospective study" — Eric Crotty (epidemiological) [Ep 5 · 12:18](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=738)
- "Cardiac MRI takes about 25 minutes and provides anatomical and functional evaluation without contrast" — Michael Taylor (clinical) [Ep 5 · 16:42](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1002)
- "Echocardiogram image quality in most pectus patients is atrocious due to the deformity" — Michael Taylor (clinical) [Ep 5 · 18:34](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1114)
- "MRI can detect the pectus compressing the anterior surface of the right ventricle, which is nearly impossible to see with echo" — Michael Taylor (clinical) [Ep 5 · 19:22](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1162)
- "One cardiac MRI is comparable in cost to an echo plus CT in most places" — Michael Taylor (opinion) [Ep 5 · 19:47](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1187)
- "Standard CT dose can deliver about 7 millisieverts of radiation, equivalent to 2 years of background radiation" — Eric Crotty (clinical) [Ep 5 · 40:10](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=2410)
- "Younger patients have higher long-term cancer risk from CT radiation due to more rapidly dividing cells" — Eric Crotty (clinical) [Ep 5 · 39:29](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=2369)
- "There is data suggesting increased risk of malignancy long term from even one CT scan" — Eric Crotty (epidemiological) [Ep 5 · 41:13](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=2473)
- "Insurance companies require evidence of cardiac dysfunction or abnormality in addition to pectus index for approval" — Victor Garcia (guideline) [Ep 5 · 31:08](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1868)
- "Bundling multiple metrics (Haller, correction, depression indices plus cardiac dysfunction) has been effective in reversing insurance denials" — Victor Garcia (opinion) [Ep 5 · 31:58](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1918)
- "When pectus orientation has sternum pressing on RV free wall, it affects right ventricular function" — Michael Taylor (clinical) [Ep 5 · 32:48](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1968)
- "Children tolerate MRI very well, especially with video goggle technology to watch movies during the procedure" — Eric Crotty (clinical) [Ep 5 · 28:15](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1695)
- "MRI can be performed with pectus bar in place with only minimal localized artifact" — Michael Taylor (clinical) [Ep 5 · 29:09](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1749)
- "The pectus geometry is three-dimensional and varies dramatically in superior-inferior dimension" — Michael Taylor (clinical) [Ep 5 · 22:20](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1340)
- "As kids age, the heart appears to get extruded into the left chest with pectus" — Michael Taylor (clinical) [Ep 5 · 26:20](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1580)
- "Dr. Park in Korea argues that repair can be done safely in patients older than 3 years" — Becky Brown (opinion) [Ep 5 · 42:15](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=2535)
- "Bars that extend all the way to mid-axillary line can impede chest wall growth in younger patients" — Victor Garcia (clinical) [Ep 5 · 42:31](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=2551)
- "Overcorrection converting excavatum to carinatum can occur, particularly in patients with connective tissue disorders" — Victor Garcia (clinical) [Ep 5 · 43:01](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=2581)
- "Park reports seeing fewer asymmetric patients when correcting at younger ages" — Victor Garcia (opinion) [Ep 5 · 43:35](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=2615)
- "Patients with connective tissue disorders are at risk for chronic pain after pectus repair" — Becky Brown (clinical) [Ep 5 · 6:32](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=392)
- "Metal allergy testing is performed in every pectus patient at this center" — Becky Brown (guideline) [Ep 5 · 6:43](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=403)
- "Cardiac MRI can screen for valve disease and aortopathy associated with connective tissue disorders" — Michael Taylor (clinical) [Ep 5 · 17:38](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1058)
- "Haller index of 3.25 originated from a retrospective study by Alec Haller in the 1980s comparing cases he fixed versus those he did not" (clinical) [Ep 9 · 4:31](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=271)
- "The Haller index study was not an earth-shattering study at the time but has been used routinely for 30 years" (opinion) [Ep 9 · 4:55](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=295)
- "Nickel allergy frequency in pectus patients is 2.8% (almost 3%) according to Nuss group data from 1200 patients" (epidemiological) [Ep 9 · 24:10](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1450)
- "Kansas City uses a questionnaire for nickel allergy screening rather than testing every patient" (clinical) [Ep 9 · 7:25](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=445)
- "Epidural catheters were removed within 24 hours or could not be placed in almost 25% of patients in a randomized trial" (clinical) [Ep 9 · 18:09](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1089)
- "Epidural group had longer OR time due to catheter placement, more phone calls to anesthesia, and greater hospital charges" (clinical) [Ep 9 · 17:35](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1055)
- "Pain scores generally favored epidural for the first 2 days, were flat on day 3, and favored PCA the last couple of days" (clinical) [Ep 9 · 17:55](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1075)
- "Kansas City series of 503 pectus excavatum repairs using subxiphoid technique had zero cardiac injuries" (clinical) [Ep 9 · 25:27](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1527)
- "In Kansas City series of 300 patients: 5% required two bars, 4% infection rate, 1.5% bar dislodgement or stabilizer discomfort requiring removal, 4 patients had bar rotation, 2 patients required chest tube" (clinical) [Ep 9 · 25:46](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1546)
- "Mean hospitalization for pectus excavatum repair in Kansas City series is 4 days" (clinical) [Ep 9 · 26:35](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1595)
- "Kansas City had 6 infections out of 168 patients over 6 years; 5 required incision and drainage, 3 developed recurrent infections, 1 required early bar removal" (clinical) [Ep 9 · 19:47](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1187)
- "Nuss group data shows results are better if bar is left in at least 2 years, with preference for 3 years" (clinical) [Ep 9 · 24:26](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1466)
- "There are about 14 or 15 reported cases of cardiac injury with the Nuss procedure worldwide" (epidemiological) [Ep 9 · 11:04](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=664)
- "Thoracoscopy is not that helpful according to Kansas City's experience, so they don't generally use it" (opinion) [Ep 9 · 12:57](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=777)
- "Everyone around the world outside of Kansas City uses thoracoscopy for Nuss repair" (opinion) [Ep 9 · 13:07](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=787)
- "Psychosocial aspects of growing up are very important, and really bad deformities should be fixed for psychosocial well-being regardless of symptoms" (opinion) [Ep 9 · 1:50](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=110)
- "Insurance companies require documented symptoms and Haller index to approve pectus repair" (guideline) [Ep 9 · 2:07](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=127)
- "Rarely do patients have real cardiorespiratory symptoms; people have spent careers trying to prove clinical significance and it remains arguable" (opinion) [Ep 9 · 2:35](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=155)
- "Some patients do have real costochondral pain that can be an issue" (clinical) [Ep 9 · 2:59](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=179)
- "Cincinnati Children's uses functional MRI cardiac studies looking at contractility, shift, and impact from pectus deformity" (clinical) [Ep 9 · 3:47](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=227)
- "Very deformed chests can have normal Haller scores due to discrepancy of both dimensions" (clinical) [Ep 9 · 4:09](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=249)
- "Transesophageal echo can detect adhesions between heart and sternum, particularly useful in redo cases to avoid cardiac injury" (clinical) [Ep 9 · 15:21](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=921)
- "Bone hook through subxiphoid incision can lift sternum to gain 1-2 millimeters of space for bar passage" (clinical) [Ep 9 · 15:45](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=945)
- "Vacuum cup suction device is used in Germany and Europe but not approved in the US" (clinical) [Ep 9 · 16:19](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=979)
- "Magnetic mini-mover procedure (3MP) is in FDA trial, 18 months into enrollment with all patients implanted, requiring another 18 months of data collection" (clinical) [Ep 9 · 27:21](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1641)
- "Dynamic compression brace for pectus carinatum requires <7.5 PSI correction pressure to be appropriate for bracing" (clinical) [Ep 9 · 30:08](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1808)
- "Brace is worn 6 to 20 months, then retainer mode for 6-12 hours per day" (clinical) [Ep 9 · 30:40](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1840)
- "Kansas City has braced 200 pectus carinatum patients with dynamic compression brace over 4 years" (clinical) [Ep 9 · 33:08](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1988)
- "Kansas City has not done a single open carinatum repair since starting bracing 4 years ago, maybe one or two at most" (clinical) [Ep 9 · 34:11](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=2051)
- "Dynamic compression brace costs around $1500-2000 total (kit plus device), billed through hospital to insurance" (clinical) [Ep 9 · 33:38](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=2018)
- "Chondrogladiolar type is the most common pectus carinatum, involving the lower sternum" (clinical) [Ep 9 · 28:45](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1725)
- "Currarino-Silverman syndrome shows a comma deformity on lateral X-ray and requires open Ravitch-type repair" (clinical) [Ep 9 · 31:02](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1862)
- "Abramson in Buenos Aires has devised a minimally invasive operation for pectus carinatum" (clinical) [Ep 9 · 31:44](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1904)
- "Patient underwent pectus repair procedure on August 1st of the previous year at age 21" — Rebecca Garcia (clinical) [Ep 12 · 0:15](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=15)
- "Patient had previously undergone Ravitch procedure in Atlanta, Georgia at age 3 or 4 years old" — Rebecca Garcia (clinical) [Ep 12 · 0:22](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=22)
- "Patient continued to experience chest pains and trouble breathing after initial Ravitch procedure" — Rebecca Garcia (clinical) [Ep 12 · 0:22](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=22)
- "Pain team response time was minimal with immediate care provided" — Rebecca Garcia (clinical) [Ep 12 · 5:11](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=311)
- "Meditation, specifically Jack Cornfield videos, was recommended by Dr. Garcia for mental recovery" — Rebecca Garcia (clinical) [Ep 12 · 1:39](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=99)
- "Postoperative restrictions included inability to turn, twist, or lift more than 5 pounds" — Rebecca Garcia (clinical) [Ep 12 · 2:19](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=139)
- "Robaxin was effective for relieving chest tightness and pressure sensations postoperatively" — Rebecca Garcia (clinical) [Ep 12 · 3:36](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=216)
- "Patient was required to wait 3 months before returning to weight training" — Rebecca Garcia (clinical) [Ep 12 · 4:15](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=255)
- "Having a pain team and protocol helps patients receive pain medicine faster without waiting for doctor orders" (opinion) [Ep 12 · 5:41](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=341)
- "Patients are screened for resistant staph preoperatively" — Garcia (clinical) [Ep 12 · 7:23](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=443)
- "Patients with resistant staph are swabbed from nose and underarms and prepared per protocol" — Garcia (clinical) [Ep 12 · 7:23](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=443)
- "Bactroban is given intranasally twice per day for 7 days prior to surgery for resistant staph carriers" (clinical) [Ep 12 · 7:37](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=457)
- "Vacuum belts cost approximately $400 to $500 and are obtained directly from Germany with patient measurements" (clinical) [Ep 12 · 8:11](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=491)
- "For minor procedures like umbilical hernia repair, activity restrictions range from none to 2 weeks" (clinical) [Ep 12 · 8:40](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=520)
- "Children typically self-limit activity when experiencing pain" (opinion) [Ep 12 · 8:51](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=531)
- "Qualifier for no activity restrictions excludes organized sports or situations where father is a coach" (clinical) [Ep 12 · 8:58](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=538)
- "Pectus patients are allowed to return to full activity after 3 months (12 weeks)" (clinical) [Ep 12 · 9:16](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=556)
- "Adolescent patients do not always adhere to 3-month activity restrictions" (clinical) [Ep 12 · 9:43](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=583)
- "After 3 months, stretching and core strength exercises are recommended using YouTube videos" (clinical) [Ep 12 · 9:54](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=594)
- "A good percentage of lower anterior rib flaring after Nuss procedure resolves spontaneously" (clinical) [Ep 12 · 10:45](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=645)
- "For older patients, Mayo Clinic technique involves breaking ribs below the repair and pushing down, but this is less effective in flexible younger patients" (clinical) [Ep 12 · 10:50](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=650)
- "Brazilian practitioners use a brace for rib flaring management" (clinical) [Ep 12 · 11:04](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=664)
- "Patients self-limit sleeping positions based on comfort, with side sleeping allowed if tolerated" (clinical) [Ep 12 · 11:33](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=693)
- "Walking and staying active were beneficial postoperatively" — Rebecca Garcia (clinical) [Ep 12 · 3:14](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=194)
- "Stretching became important postoperatively for a patient who previously never stretched" — Rebecca Garcia (clinical) [Ep 12 · 3:24](https://library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=204)
- "99% of pectus patients receive transthoracic echos reported as normal with no issues" (clinical) [Ep 15 · 1:24](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=84)
- "Transthoracic echo has difficulty obtaining adequate windows to visualize the right side of the heart" (clinical) [Ep 15 · 1:32](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=92)
- "TEE shows nearly triple the velocity or volume going through the right ventricular outflow tract post-operatively" (clinical) [Ep 15 · 2:12](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=132)
- "Left ventricular flow also shows significant improvement when right ventricular flow increases, because the heart functions as a pump" (clinical) [Ep 15 · 2:25](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=145)
- "Cardiac output can improve from 55% (normal range) to 77% in older pectus patients after repair" (clinical) [Ep 15 · 2:59](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=179)
- "Heart contractility, synchrony, and mobility show significant differences between pre-op and post-op in pectus patients" (clinical) [Ep 15 · 3:26](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=206)
- "In 168 patients studied pre and post-op, the MIRP (minimally invasive) group showed 30% increase in cardiac output" (clinical) [Ep 15 · 3:57](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=237)
- "All pectus patients together showed 24% increase in cardiac output post-operatively" (clinical) [Ep 15 · 4:24](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=264)
- "Open repair group does not improve cardiac output as much as minimally invasive group, likely because open cases include mixed pathology like malunion" (clinical) [Ep 15 · 3:57](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=237)
- "Standard Bruce protocol ischemic stress testing is not the appropriate test for pectus patients unless ischemia is suspected" (clinical) [Ep 15 · 4:53](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=293)
- "Cardiopulmonary exercise testing with VO2 measurement separates cardiac efficiency from pulmonary component, making it ideal for pectus evaluation" (clinical) [Ep 15 · 5:13](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=313)
- "VO2 max and anaerobic VO2 are very abnormal in pectus patients while other parameters remain normal" (clinical) [Ep 15 · 5:27](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=327)
- "A French study of 125 adults showed cardiopulmonary exercise parameters statistically improve and normalize after surgical pectus repair" (clinical) [Ep 15 · 5:39](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=339)
- "Pectus patients show limited ability to increase stroke volume during exercise, initially compensating with heart rate but then plateauing when volume increase is needed due to chest cage restriction" (clinical) [Ep 15 · 6:02](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=362)
- "Pectus patients show flat stroke volume curves during exercise testing while normal patients show upward slopes that peak at maximum" (clinical) [Ep 15 · 6:19](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=379)
- "Exercise testing is used 5-6 times daily in congenital heart disease clinic for decision-making about palliation and conduit replacement" — Michael (clinical) [Ep 15 · 7:23](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=443)
- "Exercise testing has not been used extensively for pectus patients alone in the cardiology practice described" — Michael (clinical) [Ep 15 · 7:39](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=459)
- "Ehlers-Danlos type 4 (vascular type) does not typically present with pectus excavatum as it is not primarily a skeletal or hypermobile disorder" (clinical) [Ep 15 · 9:03](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=543)
- "Ehlers-Danlos type 4 involves internal tissue fragility requiring specially managed repairs" (clinical) [Ep 15 · 9:21](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=561)
- "Visible veins and family history of abdominal aortic aneurysm do not indicate Ehlers-Danlos vascular type" (clinical) [Ep 15 · 10:09](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=609)
- "Younger children have more pliable chest walls, allowing repair with less force (described as 'popsicle stick' level)" (clinical) [Ep 15 · 14:51](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=891)
- "Adults have tremendous pain from pectus repair because their chest walls are rigid" (clinical) [Ep 15 · 15:01](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=901)
- "In Korea, pectus repairs are performed on 3-5 year olds with very small bar sets" (clinical) [Ep 15 · 15:06](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=906)
- "The trend in the United States has moved from repairing young patients to operating on older populations" (epidemiological) [Ep 15 · 15:18](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=918)
- "Donald Nuss initially performed pectus repairs on very young patients, as young as 3 years of age" (clinical) [Ep 15 · 15:41](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=941)
- "The Nuss institution with thousands of patients has moved away from operating on young children" (clinical) [Ep 15 · 16:37](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=997)
- "Korean surgeons repair pectus in young children routinely and report no problems, considering it unusual to wait" (clinical) [Ep 15 · 16:57](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=1017)
- "Vacuum bell works best with very flexible chest walls and requires religious compliance" (clinical) [Ep 15 · 17:52](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=1072)
- "Patient compliance with vacuum bell varies greatly, with some children only tolerating 10 minutes of use despite bribing" (clinical) [Ep 15 · 18:03](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=1083)
- "There are no randomized controlled trials separating pectus patients who received repair from those who did not" (clinical) [Ep 15 · 19:31](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=1171)
- "Selection bias exists in surgical practice because most patients seen are symptomatic, while thousands of asymptomatic adults with pectus may exist" (opinion) [Ep 15 · 19:39](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=1179)
- "95% of patients presenting to the pectus clinic are seeking surgery" (clinical) [Ep 15 · 20:25](https://library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=1225)
- "Genetic evaluation for pectus excavatum primarily screens for Marfan syndrome and Ehlers-Danlos syndrome." — Derek (clinical) [Ep 16 · 0:00](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=0)
- "In Marfan syndrome, the wrist sign (thumb and pinky finger overlap when wrapped around the wrist) and thumb protrusion past the ulnar border indicate overgrowth of long bones relative to the trunk." — Derek (clinical) [Ep 16 · 0:21](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=21)
- "Marfan skeletal findings include pectus excavatum and carinatum, scoliosis, and hindfoot deformities." — Derek (clinical) [Ep 16 · 1:00](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=60)
- "Cardiac risks in Marfan syndrome include aortic dissection and mitral valve prolapse; other complications include retinal detachments." — Derek (clinical) [Ep 16 · 1:19](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=79)
- "Marfan diagnosis centers on cardiac findings; echocardiogram or MRI are the main tools to evaluate for dilated aortic root." — Derek (clinical) [Ep 16 · 1:38](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=98)
- "Lens dislocations are evaluated in Marfan syndrome, and fibrillin gene testing is performed in cases with suggestive findings." — Derek (clinical) [Ep 16 · 1:55](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=115)
- "In patients with Marfan-like characteristics, evaluation may extend to other genetic syndromes involving TGF-beta signaling, which may contribute to aortic remodeling and long bone overgrowth." — Derek (clinical) [Ep 16 · 2:05](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=125)
- "Ehlers-Danlos syndrome is by far the more common condition evaluated in pectus patients compared to Marfan syndrome." — Derek (epidemiological) [Ep 16 · 2:27](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=147)
- "Ehlers-Danlos syndrome represents a grouping of related connective tissue conditions, not a single disorder." — Derek (clinical) [Ep 16 · 2:45](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=165)
- "Classic Ehlers-Danlos is due to defects in collagen 5 and is characterized by joint hypermobility and abnormal skin that is fragile, thin, with weak and papery thin scars." — Derek (clinical) [Ep 16 · 3:00](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=180)
- "Vascular Ehlers-Danlos is caused by mutations in collagen 3 and involves internal organ fragility (bowel, aortic, or uterine rupture) rather than hypermobile joints." — Derek (clinical) [Ep 16 · 3:17](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=197)
- "Vascular Ehlers-Danlos is one of the least common conditions seen in the pectus clinic." — Derek (epidemiological) [Ep 16 · 3:39](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=219)
- "Genetic testing for vascular Ehlers-Danlos is 99% sensitive." — Derek (clinical) [Ep 16 · 4:07](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=247)
- "The hypermobile type of Ehlers-Danlos is what is typically evaluated in the pectus clinic." — Derek (clinical) [Ep 16 · 4:23](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=263)
- "The Beighton score tests 9 different joints and is scored 1 for each side except the hips, with a maximum of 9 points." — Derek (clinical) [Ep 16 · 4:41](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=281)
- "Beighton score criteria include hyperextension of the arms past 10 degrees, hyperextension of the pinky past 90 degrees, apposition of the thumb to the forearm, hyperextension of the knee past 10 degrees, and placing hands flat on the floor without bending the knees." — Derek (clinical) [Ep 16 · 4:52](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=292)
- "A person with 5 or more hypermobile joints on the Beighton score meets criteria for generalized hypermobility." — Derek (clinical) [Ep 16 · 5:27](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=327)
- "In hypermobile Ehlers-Danlos, skin changes are mild (mildly hyperextensible, easy bruising, mild scarring abnormalities, striae)." — Derek (clinical) [Ep 16 · 5:40](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=340)
- "The dividing line between being flexible and having Ehlers-Danlos may be very fuzzy; diagnosis looks for similar findings in family members and the presence of problems." — Derek (opinion) [Ep 16 · 6:01](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=361)
- "Problems associated with hypermobile Ehlers-Danlos include joints that are loose and dislocate." — Derek (clinical) [Ep 16 · 6:25](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=385)
- "Patients with hypermobile Ehlers-Danlos exhibit a constellation of findings: chronic pain, chronic headaches and migraines, temporomandibular joint dysfunction, easy bruising and bleeding, orthostatic hypotension or dizziness or blacking out with standing, episodes of racing heartbeat, chronic constipation with irritable bowel syndrome, panic and anxiety disorders, and sleeping problems." — Derek (clinical) [Ep 16 · 6:32](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=392)
- "Most adult patients with hypermobile Ehlers-Danlos have almost all of the associated problems when they present." — Derek (epidemiological) [Ep 16 · 7:12](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=432)
- "In children with hypermobile Ehlers-Danlos, problems may be very mild or not evident, but may begin to emerge during puberty, which may coincide with consideration of pectus surgery." — Derek (clinical) [Ep 16 · 7:17](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=437)
- "The chronic pain aspect of hypermobile Ehlers-Danlos can play into whether patients are at risk for more pain from pectus surgery." — Derek (clinical) [Ep 16 · 7:33](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=453)
- "Hypermobility is a risk factor for fibromyalgia; 50% of teenagers diagnosed with fibromyalgia have hypermobility." — Derek (epidemiological) [Ep 16 · 7:42](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=462)
- "Fibromyalgia involves central sensitivity to pain, meaning patients are unable to filter out unwanted pain signals in the same way as other persons." — Derek (clinical) [Ep 16 · 7:56](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=476)
- "A hypermobile patient may be at risk for more problems with chronic pain." — Derek (clinical) [Ep 16 · 8:08](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=488)
- "Derek and his genetics team are a central component in the evaluation of pectus patients in this practice." (opinion) [Ep 16 · 8:28](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=508)
- "One surgeon screens pectus patients for double-jointedness, Marfanoid appearance (arachnodactyly), striae, and extreme flexibility (e.g., leg above head) and refers those with positive findings to genetics." (clinical) [Ep 16 · 8:41](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=521)
- "Approximately 30% of the speaker's practice consists of revision pectus cases, not all originally performed by the speaker" — Don (clinical) [Ep 14 · 0:50](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=50)
- "True incidence of pectus recurrence is unknown because many patients do not report back to centers" — Don (epidemiological) [Ep 14 · 1:22](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=82)
- "In an adult open repair series originally reporting 5% recurrence, at least 20 patients contacted for revision over the subsequent 10 years" — Don (clinical) [Ep 14 · 1:39](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=99)
- "Nuss procedure failures are typically related to technical issues: bar positioning, bar rotation, and premature removal" — Don (clinical) [Ep 14 · 2:12](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=132)
- "Open repair failures involve different mechanisms: healing issues, malunion, and regression" — Don (clinical) [Ep 14 · 2:22](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=142)
- "Once bars rotate, their ability to elevate the chest wall is lost and they usually cause pain" — Don (clinical) [Ep 14 · 3:14](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=194)
- "Lateral stripping occurs when the bar is not supported by the intercostal space and migrates posteriorly, losing forward elevation capability" — Don (clinical) [Ep 14 · 3:41](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=221)
- "In adult patients, the chest is often so stiff and rigid that intercostal spaces cannot support bar pressure, leading to ripping and bar migration" — Don (clinical) [Ep 14 · 4:41](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=281)
- "The speaker uses forced sternal elevation, reinforces intercostal spaces in heavier adults, fixes bars medially, uses multiple bars, and performs releasing osteotomies when needed" — Don (clinical) [Ep 14 · 5:11](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=311)
- "The Rultract retractor lifts and elevates the sternum during dissection, reducing force required and creating open space for thoracoscopic visualization" — Don (clinical) [Ep 14 · 5:53](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=353)
- "Fiber wire (woven PTFE suture) is used in figure-of-eight configuration around ribs and bar to prevent rib separation and bar migration" — Don (clinical) [Ep 14 · 6:53](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=413)
- "Single bar placement creates tremendous pressure and pain in heavier, stiffer chests; balancing the defect with multiple bars reduces these problems" — Don (clinical) [Ep 14 · 7:22](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=442)
- "Approximately 30% of the speaker's patients now receive 3 bars" — Don (clinical) [Ep 14 · 7:47](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=467)
- "For very low bar placement, the speaker drills through the sternum and passes suture to loop around sternum and bar centrally to prevent rotation" — Don (clinical) [Ep 14 · 7:51](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=471)
- "Optimal bar length is 2-3 centimeters beyond the lateral chest wall curve, catching side ribs but not wrapping to the back" — Don (clinical) [Ep 14 · 15:59](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=959)
- "In a series of over 300 adult pectus repairs (over 200 age 30+), the speaker could achieve elevation with Rultract in almost all patients under 30, but 11-12% of patients over 30 would not lift" — Don (clinical) [Ep 14 · 18:34](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=1114)
- "If the chest does not lift with forced elevation, bars alone will not make it lift over time" — Don (clinical) [Ep 14 · 20:22](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=1222)
- "Limited osteotomy technique involves freeing cartilages from sternum at the non-lifting site, then shortening cartilages to allow reapproximation, similar to cartilage-sparing Ravitch" — Don (clinical) [Ep 14 · 20:41](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=1241)
- "In older patients with calcified cartilage, the classic cartilage-sparing perichondrial preservation technique is often not feasible due to adhesions" — Don (clinical) [Ep 14 · 24:43](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=1483)
- "Osteotomies require open approach; thoracoscopic cartilage resection is possible but difficult and still requires stabilization with sutures or plates" — Don (opinion) [Ep 14 · 25:50](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=1550)
- "Redo open repairs that did not achieve support can often be successfully revised with Nuss bars as they lift easily" — Don (clinical) [Ep 14 · 30:00](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=1800)
- "Patients with evidence of hernia, malunion, or thoracic dystrophy automatically require open revision" — Don (clinical) [Ep 14 · 30:31](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=1831)
- "All complex revision cases are prepped with groins exposed to allow emergent femoral bypass access in case of life-threatening bleeding" — Don (clinical) [Ep 14 · 31:29](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=1889)
- "Anterior plating is used on all complex revision cases because bars alone led to recurrence when removed" — Don (clinical) [Ep 14 · 31:43](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=1903)
- "Malunion or pseudoarthrosis is best assessed by physical exam; CT scans show ribs not attached to sternum as the key finding" — Don (clinical) [Ep 14 · 32:54](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=1974)
- "Patients with malunion have pain, inability to Valsalva, and paradoxical chest wall movement, but Haller index can be nearly normal, leading to misdiagnosis" — Don (clinical) [Ep 14 · 33:42](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=2022)
- "Malunion reconstruction requires stabilization with plating, often bone graft or methylmethacrylate to fill spaces, and sometimes mesh coverage" — Don (clinical) [Ep 14 · 34:01](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=2041)
- "On thin patients, complete soft tissue coverage of plates is critical; biologic mesh can be used when pectoralis muscles have atrophied and cannot be mobilized to cover hardware" — Don (clinical) [Ep 14 · 35:20](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=2120)
- "Chest wall hernias can show dynamic collapse visible only on expiratory phase CT imaging, with Haller index changing from 2.2 on inspiration to 5.0 on expiration" — Don (clinical) [Ep 14 · 40:01](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=2401)
- "Methylmethacrylate, titanium mesh, titanium plates, or prefabricated titanium parts can be used for chest wall reconstruction" — Don (clinical) [Ep 14 · 40:44](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=2444)
- "Complex revision patients are never completely normal again; the goal is to make them better, not perfect" — Don (opinion) [Ep 14 · 41:17](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=2477)
- "Multiple revisions become futile in connective tissue disorders or chests that will not heal, leading to cycles of infection and osteonecrosis" — Don (clinical) [Ep 14 · 42:10](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=2530)
- "The best operation is the first operation; there is a significant learning curve for pectus repair that is not adequately recognized" — Garcia (opinion) [Ep 14 · 43:21](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=2601)
- "Chronic pain requiring narcotics is a major complication in revision cases" — Garcia (clinical) [Ep 14 · 43:09](https://library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=2589)
- "Cardiac MRI for pectus assessment provides comprehensive examination including anatomical features and cardiac function without radiation" — Eric Crotty (clinical) [Ep 11 · 2:31](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=151)
- "CT dose for pectus imaging can reach 7 millisieverts, equivalent to 2 years of background radiation" — Eric Crotty (clinical) [Ep 11 · 35:09](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=2109)
- "Haller index measurements can vary significantly based on respiratory phase (end inspiration vs end expiration)" — Eric Crotty (clinical) [Ep 11 · 4:47](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=287)
- "Some patients with clinically obvious pectus excavatum have normal Haller index at end inspiration" — Eric Crotty (clinical) [Ep 11 · 5:21](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=321)
- "Haller's original cutoff of 3.25 was based on observational study, not rigorous scientific methodology" — Eric Crotty (epidemiological) [Ep 11 · 7:01](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=421)
- "Correction index >10% shows no overlap between normal patients and those with pectus excavatum" — Eric Crotty (clinical) [Ep 11 · 8:22](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=502)
- "Depression index >0.2 accounts for variable chest shape (barrel vs elliptical) in pectus assessment" — Eric Crotty (clinical) [Ep 11 · 8:46](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=526)
- "Barrel-shaped chest configuration can result in normal Haller index despite significant pectus deformity" — Eric Crotty (clinical) [Ep 11 · 9:17](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=557)
- "Cardiac MRI provides functional evaluation in addition to anatomical assessment, all without contrast, in approximately 25 minutes" — Michael Taylor (clinical) [Ep 11 · 11:25](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=685)
- "Echocardiogram image quality in pectus patients is typically poor due to chest wall deformity" — Michael Taylor (clinical) [Ep 11 · 13:23](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=803)
- "Cardiac MRI can visualize pectus compression on anterior surface of right ventricle, which is impossible to see on echocardiogram" — Michael Taylor (clinical) [Ep 11 · 14:05](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=845)
- "Approximately 15% of pectus patients have right ventricular ejection fraction less than 50% (normal is ≥50%)" — Michael Taylor (clinical) [Ep 11 · 16:18](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=978)
- "Pectus excavatum geometry is markedly heterogeneous in three dimensions and varies in superior-inferior dimension" — Michael Taylor (clinical) [Ep 11 · 17:04](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1024)
- "Patients with RV compression have depressed right ventricular ejection fractions" — Michael Taylor (clinical) [Ep 11 · 17:52](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1072)
- "Compression of RV free wall (vs RA-RV groove) is associated with more decreased RV function" — Michael Taylor (clinical) [Ep 11 · 18:14](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1094)
- "Children can be asymptomatic with RV ejection fractions in the 40s" — Michael Taylor (clinical) [Ep 11 · 19:15](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1155)
- "Decreased RV function manifests more clearly during formal cardiopulmonary exercise testing" — Michael Taylor (clinical) [Ep 11 · 19:22](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1162)
- "Most pediatric MRI centers can perform cardiac MRI for pectus assessment using fairly basic sequences" — Eric Crotty (clinical) [Ep 11 · 22:15](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1335)
- "Children tolerate MRI well, especially with video goggle technology allowing them to watch movies during the procedure" — Eric Crotty (clinical) [Ep 11 · 23:00](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1380)
- "Cardiac MRI does not require sedation or contrast for pectus assessment" — Eric Crotty (clinical) [Ep 11 · 23:37](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1417)
- "MRI can be performed after pectus bar placement with only minimal localized artifact where bar overlies the heart" — Michael Taylor (clinical) [Ep 11 · 23:53](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1433)
- "Insurance companies may deny pectus surgery if only Haller index is provided, requiring additional metrics and cardiac dysfunction evidence" (guideline) [Ep 11 · 26:19](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1579)
- "Bundle of correction index, depression index, and cardiac dysfunction evidence is effective in reversing insurance denials" (guideline) [Ep 11 · 26:50](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1610)
- "When sternum presses on RV free wall, it affects right ventricular function" — Michael Taylor (clinical) [Ep 11 · 27:32](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1652)
- "Cardiac MRI reports aortic root dimensions and can detect mitral valve prolapse in Marfan patients" — Michael Taylor (clinical) [Ep 11 · 28:49](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1729)
- "Older pectus patients tend to have heart extruded more into left chest, possibly a growth/developmental phenomenon" — Michael Taylor (clinical) [Ep 11 · 21:12](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1272)
- "Earlier CT exposure and higher CT dose increase long-term risk of malignancy development" — Eric Crotty (epidemiological) [Ep 11 · 34:13](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=2053)
- "Pediatric tissues have more rapidly dividing cells with more time to develop DNA breaks, increasing complication likelihood from CT" — Eric Crotty (clinical) [Ep 11 · 34:38](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=2078)
- "Even one CT scan shows increased risk of long-term malignancy, with risk increasing the younger the patient" — Eric Crotty (epidemiological) [Ep 11 · 35:57](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=2157)
- "Dr. Park in Korea reports that pectus surgery is safe in patients older than 3 years" — Becky (guideline) [Ep 11 · 36:59](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=2219)
- "Shorter bars are required for younger patients to avoid impeding chest wall growth" (clinical) [Ep 11 · 37:15](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=2235)
- "Early correction can convert excavatum to carinatum, particularly in patients with connective tissue disorders" (clinical) [Ep 11 · 37:45](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=2265)
- "Dr. Park reports fewer asymmetric pectus cases when correcting patients at younger ages" (epidemiological) [Ep 11 · 38:18](https://library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=2298)
- "Joe La Hillier is a general surgery intern at the University of Buffalo" — Joe La Hillier (clinical) [Ep 21 · 2:49](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=169)
- "Vic is a PGY4 resident from UT Southwestern in Dallas, doing lab work at UT Houston McGovern Medical School studying diaphragmatic hernia" — Vic (clinical) [Ep 21 · 3:11](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=191)
- "The ventricular dysfunction study is from December 2019 in American Journal of Respiratory and Critical Care Medicine" — Vic (clinical) [Ep 21 · 4:11](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=251)
- "The first author is Neil Pattel, a neonatologist from Glasgow, and the senior author is Doctor Harding" — Vic (clinical) [Ep 21 · 4:16](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=256)
- "The study used CDH Study Group data from 2015 to 2018 as a retrospective review of prospectively collected data" — Vic (clinical) [Ep 21 · 4:31](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=271)
- "The primary outcome was survival to discharge, examining early cardiac dysfunction on echo within the first 48 hours of life" — Vic (clinical) [Ep 21 · 4:48](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=288)
- "Patients were split into four groups: normal ventricular function, right ventricular dysfunction only, left ventricular dysfunction only, and biventricular dysfunction" — Vic (clinical) [Ep 21 · 4:58](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=298)
- "39% of CDH patients had some evidence of cardiac dysfunction on their first echogram in the first 48 hours of life" — Vic (clinical) [Ep 21 · 5:19](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=319)
- "Cardiac dysfunction was an independent predictor of mortality and outcomes" — Vic (clinical) [Ep 21 · 5:30](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=330)
- "Patients with normal cardiac function had survival over 80%" — Vic (clinical) [Ep 21 · 5:36](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=336)
- "Patients with right ventricular dysfunction only had survival of 74%" — Vic (clinical) [Ep 21 · 5:42](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=342)
- "Patients with left ventricular dysfunction had survival of 57%" — Vic (clinical) [Ep 21 · 5:42](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=342)
- "Patients with biventricular dysfunction had survival of 50%" — Vic (clinical) [Ep 21 · 5:42](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=342)
- "Even when adjusting for liver position, defect size, and other important variables, cardiac dysfunction was still a significant driver of mortality" — Vic (clinical) [Ep 21 · 6:01](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=361)
- "The authors push for the importance of evaluating early cardiac function in CDH patients with an early echocardiogram in the first 48 hours of life" — Vic (guideline) [Ep 21 · 6:23](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=383)
- "The CDH study group does not prescribe standardized management and does not tell institutions how to standardize management" — Vic (clinical) [Ep 21 · 7:01](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=421)
- "The data collection tool asks if early echo was done, what day, and whether there was cardiac dysfunction (right ventricular dysfunction yes or no, and if yes, was it systolic or diastolic)" — Vic (clinical) [Ep 21 · 7:08](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=428)
- "Pulmonary hypertension is a predictor of mortality for CDH infants" — Vic (clinical) [Ep 21 · 7:30](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=450)
- "With pulmonary hypertension you can see decreased right ventricular ejection" — Vic (clinical) [Ep 21 · 7:35](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=455)
- "Decreased right ventricular ejection can lead to bowing of the septum into the left ventricle" — Vic (clinical) [Ep 21 · 7:39](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=459)
- "Septal bowing can result in decreased ventricular volumes and decreased ejection" — Vic (clinical) [Ep 21 · 7:45](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=465)
- "The pectus repair study is entitled 'Standardization of Clinical Care Pathway Leads to Sustained decreased length of Stay Following Nuss pectus repair, a multi-disciplinary quality improvement initiative' by senior authors Doctor Garcia and Doctor Brown from Cincinnati Children's" — Joe La Hillier (clinical) [Ep 21 · 11:14](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=674)
- "The authors created a standardized post-operative protocol for patients undergoing Nuss procedure for pectus deformity" — Joe La Hillier (clinical) [Ep 21 · 11:31](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=691)
- "The protocol employed tactics like scheduling anti-emetics, good pain control using epidurals but discontinuing them early on post-op day 2, removing Foleys early, and encouraging ambulation" — Joe La Hillier (clinical) [Ep 21 · 11:42](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=702)
- "Outcome measures were activity, lung recruitment, pain control, and ins and outs" — Joe La Hillier (clinical) [Ep 21 · 11:58](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=718)
- "The protocol decreased length of stay following Nuss pectus repair from 4.4 days to 3.4 days" — Joe La Hillier (clinical) [Ep 21 · 12:06](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=726)
- "There were zero readmissions out of 164 patients" — Joe La Hillier (clinical) [Ep 21 · 12:15](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=735)
- "The study showed high patient satisfaction scores and low pain scores on telephone follow-up" — Joe La Hillier (clinical) [Ep 21 · 12:21](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=741)
- "The protocol emphasized multidisciplinary management with stakeholders including pediatric surgery, anesthesiologists, nurse educators, advanced practice providers, physical therapy, occupational therapy, respiratory therapy, and QI personnel" — Joe La Hillier (clinical) [Ep 21 · 13:08](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=788)
- "The Cincinnati group did not use any cryotherapy for pain control on any patients in this study" — Joe La Hillier (clinical) [Ep 21 · 13:57](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=837)
- "At University of Wisconsin they use cryotherapy for pectus repair, and at Buffalo they do not" — Joe La Hillier (clinical) [Ep 21 · 14:02](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=842)
- "Cryotherapy is gaining traction and faculty using it believe it works" — Vic (opinion) [Ep 21 · 14:15](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=855)
- "Studies show cryo versus epidurals showed no difference in pain control but decreased length of stay with cryotherapy" — Joe La Hillier (clinical) [Ep 21 · 14:29](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=869)
- "The Cincinnati authors expressed reservations about cryotherapy due to lack of significant long-term outcomes data" — Joe La Hillier (opinion) [Ep 21 · 14:40](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=880)
- "Kansas City has published quite a bit about cryotherapy and shown good results" — Todd Ponsky (clinical) [Ep 21 · 14:57](https://library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=897)
- "Patient underwent Ravitch procedure in Atlanta, Georgia at age 3 or 4 years old" — Rebecca Garcia (clinical) [Ep 22 · 0:22](https://library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=22)
- "Patient continued to have chest pains and trouble breathing after initial Ravitch procedure" — Rebecca Garcia (clinical) [Ep 22 · 0:22](https://library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=22)
- "Patient underwent second pectus procedure on August 1st at age 21" — Rebecca Garcia (clinical) [Ep 22 · 0:15](https://library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=15)
- "Meditation, specifically Jack Kornfield videos, helped with mental aspects of recovery" — Rebecca Garcia (opinion) [Ep 22 · 1:39](https://library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=99)
- "Postoperative restrictions included inability to turn, twist, or lift more than 5 pounds" — Rebecca Garcia (clinical) [Ep 22 · 2:19](https://library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=139)
- "Robaxin helped relieve chest tightness and pressure sensations during recovery" — Rebecca Garcia (clinical) [Ep 22 · 3:36](https://library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=216)
- "Patient waited 3 months before returning to weight training as instructed" — Rebecca Garcia (clinical) [Ep 22 · 4:15](https://library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=255)
- "Pain team response time was minimal with little to no delay" — Rebecca Garcia (clinical) [Ep 22 · 5:11](https://library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=311)
- "Having a pain team and protocol helps patients receive pain medicine faster without waiting for doctor orders" (clinical) [Ep 22 · 5:41](https://library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=341)
- "Patients are screened for resistant staph preoperatively" — Garcia (clinical) [Ep 22 · 7:23](https://library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=443)
- "If resistant staph is detected, patients are swabbed from nose and underarms" — Garcia (clinical) [Ep 22 · 7:29](https://library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=449)
- "Bactroban is given intranasally twice per day for 7 days prior to surgery for resistant staph carriers" (clinical) [Ep 22 · 7:40](https://library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=460)
- "Vacuum belt costs approximately $400-500 and is obtained directly from Germany with patient measurements" — Victor (clinical) [Ep 22 · 8:11](https://library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=491)
- "For minor procedures like umbilical hernia, no activity restrictions are imposed or 2-week restriction is given" — Victor (clinical) [Ep 22 · 8:40](https://library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=520)
- "For pectus patients, full activity is allowed after 3 months (12 weeks)" — Victor (clinical) [Ep 22 · 9:16](https://library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=556)
- "After 3 months, stretching and core strength exercises are recommended using YouTube videos" — Victor (clinical) [Ep 22 · 9:54](https://library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=594)
- "A good percentage of lower anterior rib flaring after Nuss procedure resolves on its own" — Victor (clinical) [Ep 22 · 10:45](https://library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=645)
- "For older patients with rib flaring, ribs can be broken below the repair and pushed down, but this is less effective in flexible children" — Victor (clinical) [Ep 22 · 10:50](https://library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=650)
- "Patients can sleep on their side if comfortable, as all people move during sleep regardless of intended position" — Victor (clinical) [Ep 22 · 11:33](https://library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=693)
- "Pectus excavatum affects 1 in about 400 patients" — Luke Reddick (epidemiological) [Ep 24 · 0:36](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=36)
- "Pectus excavatum has a male predominance at about a 4:1 ratio" — Luke Reddick (epidemiological) [Ep 24 · 0:39](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=39)
- "The Nuss procedure is the gold standard for pectus excavatum fixation" — Luke Reddick (guideline) [Ep 24 · 0:39](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=39)
- "The Nuss procedure has been historically associated with a significant amount of pain leading to increased hospital lengths of stay and costs" — Luke Reddick (clinical) [Ep 24 · 0:46](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=46)
- "Intercostal nerve cryoablation has helped patients with pain and decreased length of stay" — Luke Reddick (clinical) [Ep 24 · 0:57](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=57)
- "Intercostal nerve cryoablation was performed at sites T3 through T7 on both sides of the chest" — Luke Reddick (clinical) [Ep 24 · 1:23](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=83)
- "Patients have been in pain for about 24 hours after intercostal nerve cryoablation because it sometimes takes that long for the full effects to kick in" — Luke Reddick (clinical) [Ep 24 · 1:31](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=91)
- "Bupivacaine was used proximal to the site of intercostal nerve cryoablation for the intercostal nerve block" — Luke Reddick (clinical) [Ep 24 · 1:55](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=115)
- "There were 15 patients in both study groups, all male" — Luke Reddick (clinical) [Ep 24 · 2:23](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=143)
- "Patient characteristics were similar in both groups with regards to Haller index, pectus correction index, age, and ethnicity" — Luke Reddick (clinical) [Ep 24 · 2:26](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=146)
- "Follow-up in the INB group was 7.5 months, whereas follow-up in the INC group was 29 months" — Luke Reddick (clinical) [Ep 24 · 2:36](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=156)
- "10 out of 15 patients in the INB group were discharged on postoperative day zero, with the remaining 5 discharged on postoperative day one" — Luke Reddick (clinical) [Ep 24 · 2:42](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=162)
- "None of the patients in the INC group were discharged prior to postoperative day 2" — Luke Reddick (clinical) [Ep 24 · 2:53](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=173)
- "Length of stay was decreased in the INB group at 12 hours compared to 58 hours in the INC group" — Luke Reddick (clinical) [Ep 24 · 2:59](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=179)
- "OR time was the same in both groups" — Luke Reddick (clinical) [Ep 24 · 3:04](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=184)
- "Cost was statistically significantly less in the INB group compared to the INC group" — Luke Reddick (clinical) [Ep 24 · 3:07](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=187)
- "Amount of opioids used were statistically significantly less in the INB group than the INC group" — Luke Reddick (clinical) [Ep 24 · 3:07](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=187)
- "10 patients in the INB group never used opioids after discharge, whereas the remaining 5 used them sparingly" — Luke Reddick (clinical) [Ep 24 · 3:19](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=199)
- "Zero patients in the INB group returned to the emergency department, whereas 4 in the INC group returned to the emergency department" — Luke Reddick (clinical) [Ep 24 · 3:49](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=229)
- "Medical devices typically are not subjected to the same rigorous, robust trials that drugs are" — Victor Garcia (guideline) [Ep 24 · 4:53](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=293)
- "Many adverse consequences for medical devices are either underreported or not reported, as suggested by Kaiser Health News" — Victor Garcia (clinical) [Ep 24 · 5:24](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=324)
- "Long-term consequences of cryoablation are unknown, particularly for children" — Victor Garcia (opinion) [Ep 24 · 5:41](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=341)
- "There is concern about chronic neuropathic pain as a consequence of cryoablation" — Victor Garcia (opinion) [Ep 24 · 5:52](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=352)
- "Patients previously stayed 7, 8, or 9 days in the hospital with thoracic epidurals for Nuss procedure" — Luke Reddick (clinical) [Ep 24 · 7:08](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=428)
- "With introduction of intercostal nerve cryoablation, patients stayed in the hospital for 3 days" — Luke Reddick (clinical) [Ep 24 · 7:16](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=436)
- "Long-term neuropathy rate with cryoablation is very low in their patient population" — Luke Reddick (clinical) [Ep 24 · 6:39](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=399)
- "High rates of neuropathy have not been observed in their patients with cryoablation" — Luke Reddick (clinical) [Ep 24 · 7:29](https://library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=449)
- "A randomized trial of 110 patients comparing epidural and PCA for pectus excavatum pain control showed epidurals did not provide superior pain relief" — Sean St. Peter (clinical) [Ep 25 · 1:07](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=67)
- "After implementing cryoanalgesia, patients went home on post-operative day one, leading to loss of equipoise in the trial comparing it to epidural/PCA" — Sean St. Peter (clinical) [Ep 25 · 1:33](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=93)
- "Cryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain" — Ellen Encisco (clinical) [Ep 25 · 1:57](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=117)
- "Cryoanalgesia technique involves freezing underneath ribs 4 through 7 for 2 minutes per rib" — Sean St. Peter (clinical) [Ep 25 · 2:19](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=139)
- "Cryoanalgesia should not be performed on rib 8 or below due to risk of abdominal wall paralysis" — Sean St. Peter (clinical) [Ep 25 · 2:29](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=149)
- "With cryoanalgesia, length of stay decreased from 4 days to 1 day" — Sean St. Peter (clinical) [Ep 25 · 2:37](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=157)
- "Cryoanalgesia dramatically reduced median morphine equivalents compared to previous pain management approaches" — Sean St. Peter (clinical) [Ep 25 · 2:46](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=166)
- "There are no long-term studies on cryoanalgesia outcomes" — Victor Garcia (clinical) [Ep 25 · 3:04](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=184)
- "Medical devices and implants are not required to undergo clinical trials before market introduction, unlike drugs" — Victor Garcia (guideline) [Ep 25 · 3:24](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=204)
- "Erector spinal catheters are placed by the pain team with ultrasound guidance and are juxtaposed to but not in the vertebral space" — Victor Garcia (clinical) [Ep 25 · 4:09](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=249)
- "With erector spinal catheters, hospital stay is 2 days, catheters stay in for 5 days total, and are removed by family on day 3 at home" — Victor Garcia (clinical) [Ep 25 · 4:19](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=259)
- "Erector spinal catheters reduced opioid requirements both in hospital and after discharge" — Victor Garcia (clinical) [Ep 25 · 4:33](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=273)
- "Cryoanalgesia changed patient condition at discharge - not just earlier discharge but better functional status at time of discharge" — Steven Rothenberg (opinion) [Ep 25 · 5:08](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=308)
- "Multimodal pain therapy should include preoperative counseling, gabapentin pre and postoperatively, methadone, clonidine, bowel regimen medications, and anti-emetics" — Todd Ponsky (clinical) [Ep 25 · 6:02](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=362)
- "With multimodal pain regimen at Nebraska, length of stay is under 2 days and patients are off opioids by 1 week" — Todd Ponsky (clinical) [Ep 25 · 6:19](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=379)
- "Bar flips typically occur early and are due to the bar sitting in a bad position, not being wrapped tight enough, or not being secured well" — Sean St. Peter (clinical) [Ep 25 · 6:39](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=399)
- "Bar flippage is completely a surgical technique issue" — Steven Rothenberg (opinion) [Ep 25 · 6:59](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=419)
- "Computational modeling shows shorter flat bars have more pressure on the sternum and are therefore more stable than traditional U-shaped bars" — Todd Ponsky (clinical) [Ep 25 · 7:40](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=460)
- "Sternal elevator use allows less tissue damage and better repair in deep stiff pectus cases" — Steven Rothenberg (clinical) [Ep 25 · 8:27](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=507)
- "Sternal elevator allows entry and exit at the same interspace" — Victor Garcia (clinical) [Ep 25 · 8:40](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=520)
- "Passing the bar from left chest to right chest is safer because the opposite direction points the instrument directly at the ventricle" — Bethany Slater (clinical) [Ep 25 · 9:31](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=571)
- "A randomized trial of 110 patients comparing epidural and PCA for pectus excavatum pain control showed epidurals did not provide superior pain relief" — Sean St. Peter (clinical) [Ep 26 · 1:07](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=67)
- "After implementing cryoanalgesia, patients went home on post-operative day one" — Sean St. Peter (clinical) [Ep 26 · 1:33](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=93)
- "Cryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain" — Ellen Encisco (clinical) [Ep 26 · 1:57](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=117)
- "Cryoanalgesia technique involves freezing ribs 4 through 7 for 2 minutes per rib" — Sean St. Peter (clinical) [Ep 26 · 2:19](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=139)
- "Cryoanalgesia should not be performed on rib 8 or below because it can cause abdominal wall paralysis" — Sean St. Peter (clinical) [Ep 26 · 2:29](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=149)
- "With cryoanalgesia, length of stay decreased from 4 days to 1 day" — Sean St. Peter (clinical) [Ep 26 · 2:37](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=157)
- "Median morphine equivalents with cryoanalgesia are dramatically lower than with previous pain control methods" — Sean St. Peter (clinical) [Ep 26 · 2:46](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=166)
- "There are no long-term studies on cryoanalgesia outcomes" — Victor Garcia (clinical) [Ep 26 · 3:04](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=184)
- "Medical devices and implants are not required to undergo clinical trials before market introduction, unlike drugs" — Victor Garcia (guideline) [Ep 26 · 3:24](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=204)
- "Erector spinal catheters are placed by the pain team with ultrasound guidance and are juxtaposed to but not in the vertebral space" — Victor Garcia (clinical) [Ep 26 · 4:09](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=249)
- "With erector spinal catheters, hospital stay is 2 days, catheters stay in for 5 days total and are removed by family on day 3 at home" — Victor Garcia (clinical) [Ep 26 · 4:19](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=259)
- "Erector spinal catheters reduce opioid requirements both in hospital and after discharge" — Victor Garcia (clinical) [Ep 26 · 4:33](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=273)
- "With cryoanalgesia, patients feel significantly better when discharged compared to other pain control methods" — Steven Rothenberg (opinion) [Ep 26 · 5:08](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=308)
- "Multimodal pain therapy components include preoperative counseling, gabapentin pre and postoperatively, methadone, clonidine, bowel regimen medications, and anti-emetics" — Todd Ponsky (clinical) [Ep 26 · 6:02](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=362)
- "With multimodal pain regimen at Nebraska, length of stay is under 2 days and patients are off opioids by 1 week" — Todd Ponsky (clinical) [Ep 26 · 6:19](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=379)
- "Bar flippage typically occurs early and is due to the bar sitting in an incorrect interspace, not being wrapped tightly enough, or not being secured well" — Sean St. Peter (clinical) [Ep 26 · 6:39](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=399)
- "Bar flippage is completely a surgical technique issue" — Steven Rothenberg (opinion) [Ep 26 · 6:59](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=419)
- "Computational modeling shows shorter flat bars have more pressure on the sternum and are therefore more stable than traditional U-shaped bars" — Todd Ponsky (clinical) [Ep 26 · 7:40](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=460)
- "Sternal elevator is used in about 10% of cases, primarily in really deep stiff pectuses to allow less tissue damage" — Steven Rothenberg (clinical) [Ep 26 · 8:19](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=499)
- "Using sternal elevator allows passage in and out at the same interspace without guesswork" — Victor Garcia (clinical) [Ep 26 · 8:40](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=520)
- "Multiple safety techniques (thoracoscopy, sternal elevator, vacuum bell, subxiphoid incision) can be used to avoid cardiac injury during bar passage" — Sean St. Peter (clinical) [Ep 26 · 8:59](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=539)
- "Passing the bar from left chest to right chest means the introducer is not pointing directly at the ventricle" — Bethany Slater (clinical) [Ep 26 · 9:31](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=571)
- "Direction of bar passage (left-to-right versus right-to-left) is surgeon preference as long as substernal space is well dissected and visualization is clear" — Sean St. Peter (opinion) [Ep 26 · 10:12](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=612)
- "The Haller index and correction index are the currently primarily used indices for pectus excavatum and tell us about the severity of the deformity." — Ellen Encisco (clinical) [Ep 29 · 0:11](https://library.globalcastmd.com/watch/novel-index-to-estimate-the-cephalocaudal-extent-of-the-excavation-in-pectus-excavatum-jps-article-6617?t=11)
- "The Titanic index takes into account the extent of the pectus excavatum deformity." — Ellen Encisco (clinical) [Ep 29 · 0:19](https://library.globalcastmd.com/watch/novel-index-to-estimate-the-cephalocaudal-extent-of-the-excavation-in-pectus-excavatum-jps-article-6617?t=19)
- "The Titanic index is calculated as the percentage of the sternum that lies behind the anterior costal line as seen on CT scans." — Ellen Encisco (clinical) [Ep 29 · 0:25](https://library.globalcastmd.com/watch/novel-index-to-estimate-the-cephalocaudal-extent-of-the-excavation-in-pectus-excavatum-jps-article-6617?t=25)
- "The study was a retrospective review of patients at an institution in Argentina who had undergone minimally invasive repair of pectus excavatum." — Ellen Encisco (clinical) [Ep 29 · 0:35](https://library.globalcastmd.com/watch/novel-index-to-estimate-the-cephalocaudal-extent-of-the-excavation-in-pectus-excavatum-jps-article-6617?t=35)
- "The study found a weak correlation between the Titanic index and the other indices (Haller and correction index)." — Ellen Encisco (clinical) [Ep 29 · 0:46](https://library.globalcastmd.com/watch/novel-index-to-estimate-the-cephalocaudal-extent-of-the-excavation-in-pectus-excavatum-jps-article-6617?t=46)
- "The Titanic index might be more helpful for helping determine how many bars a patient is going to need for repair." — Ellen Encisco (clinical) [Ep 29 · 0:46](https://library.globalcastmd.com/watch/novel-index-to-estimate-the-cephalocaudal-extent-of-the-excavation-in-pectus-excavatum-jps-article-6617?t=46)
- "The threshold established was 66.5%, meaning that patients with a higher Titanic index than that probably needed more than 2 bars." — Ellen Encisco (clinical) [Ep 29 · 0:57](https://library.globalcastmd.com/watch/novel-index-to-estimate-the-cephalocaudal-extent-of-the-excavation-in-pectus-excavatum-jps-article-6617?t=57)
- "More study is needed for this index." — Ellen Encisco (opinion) [Ep 29 · 1:06](https://library.globalcastmd.com/watch/novel-index-to-estimate-the-cephalocaudal-extent-of-the-excavation-in-pectus-excavatum-jps-article-6617?t=66)
- "Thoracic epidural and intercostal nerve cryoablation are two options for pain control in patients undergoing a Nuss procedure for pectus excavatum" — Alex Halpern (clinical) [Ep 32 · 0:00](https://library.globalcastmd.com/watch/cost-and-outcomes-of-intercostal-nerve-cryoablation-versus-thoracic-epidural-following-the-nuss-procedure-7313?t=0)
- "Dr. Tsai and his team from Penn State conducted a retrospective chart review looking at kids who underwent a Nuss procedure between 2002 and 2020" — Alex Halpern (clinical) [Ep 32 · 0:19](https://library.globalcastmd.com/watch/cost-and-outcomes-of-intercostal-nerve-cryoablation-versus-thoracic-epidural-following-the-nuss-procedure-7313?t=19)
- "The intercostal nerve cryoablation group had lower rates of PCA use compared to thoracic epidural" — Alex Halpern (clinical) [Ep 32 · 0:21](https://library.globalcastmd.com/watch/cost-and-outcomes-of-intercostal-nerve-cryoablation-versus-thoracic-epidural-following-the-nuss-procedure-7313?t=21)
- "The intercostal nerve cryoablation group had lower total morphine milligram equivalent requirement compared to thoracic epidural" — Alex Halpern (clinical) [Ep 32 · 0:21](https://library.globalcastmd.com/watch/cost-and-outcomes-of-intercostal-nerve-cryoablation-versus-thoracic-epidural-following-the-nuss-procedure-7313?t=21)
- "The intercostal nerve cryoablation group had shorter length of stay in the hospital compared to thoracic epidural" — Alex Halpern (clinical) [Ep 32 · 0:21](https://library.globalcastmd.com/watch/cost-and-outcomes-of-intercostal-nerve-cryoablation-versus-thoracic-epidural-following-the-nuss-procedure-7313?t=21)
- "The intercostal nerve cryoablation group had longer operative times compared to thoracic epidural" — Alex Halpern (clinical) [Ep 32 · 0:44](https://library.globalcastmd.com/watch/cost-and-outcomes-of-intercostal-nerve-cryoablation-versus-thoracic-epidural-following-the-nuss-procedure-7313?t=44)
- "The intercostal nerve cryoablation group had higher total hospitalization cost than the thoracic epidural group" — Alex Halpern (clinical) [Ep 32 · 0:44](https://library.globalcastmd.com/watch/cost-and-outcomes-of-intercostal-nerve-cryoablation-versus-thoracic-epidural-following-the-nuss-procedure-7313?t=44)
- "Both intercostal nerve cryoablation and thoracic epidural have pros and cons for pain control following Nuss procedure" — Alex Halpern (opinion) [Ep 32 · 0:51](https://library.globalcastmd.com/watch/cost-and-outcomes-of-intercostal-nerve-cryoablation-versus-thoracic-epidural-following-the-nuss-procedure-7313?t=51)
- "The study was a retrospective single institution study conducted in Phoenix from 2017 to 2021" — Cecilia Gigena (clinical) [Ep 33 · 0:10](https://library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334?t=10)
- "The study compared patients who underwent Nuss procedure with cryoanalgesia in the first quarter of institutional experience versus the fourth quarter" — Cecilia Gigena (clinical) [Ep 33 · 0:16](https://library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334?t=16)
- "350 patients underwent Nuss procedure with cryoanalgesia in the study period" — Cecilia Gigena (epidemiological) [Ep 33 · 0:29](https://library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334?t=29)
- "Patients in the last quarter were discharged 1.3 days earlier than patients in the first quarter" — Cecilia Gigena (clinical) [Ep 33 · 0:34](https://library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334?t=34)
- "Patients in the last quarter required 74% less opioids compared to the first quarter" — Cecilia Gigena (clinical) [Ep 33 · 0:34](https://library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334?t=34)
- "Experience plays a role in cryoanalgesia outcomes for Nuss procedures" — Cecilia Gigena (opinion) [Ep 33 · 0:46](https://library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334?t=46)
- "The study was a retrospective review conducted in Phoenix between 2018 and 2022" — Cecilia Gigena (clinical) [Ep 35 · 0:11](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=11)
- "The study compared length of stay and opiate use in patients undergoing cartilaginous rib excision with and without cryo" — Cecilia Gigena (clinical) [Ep 35 · 0:16](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=16)
- "The study included 98 patients total" — Cecilia Gigena (epidemiological) [Ep 35 · 0:27](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=27)
- "68 patients underwent resection without cryo" — Cecilia Gigena (epidemiological) [Ep 35 · 0:27](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=27)
- "22 patients underwent resection with cryo" — Cecilia Gigena (epidemiological) [Ep 35 · 0:27](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=27)
- "8 patients underwent a NAS procedure plus cartilaginous resection with cryoalgesia" — Cecilia Gigena (epidemiological) [Ep 35 · 0:27](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=27)
- "Patients who underwent resection with cryo had significantly less opiate use" — Cecilia Gigena (clinical) [Ep 35 · 0:43](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=43)
- "Patients who underwent resection with cryo stayed one day less than patients without cryo, though this difference was not statistically significant" — Cecilia Gigena (clinical) [Ep 35 · 0:43](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=43)
- "The Haller index and correction index are currently the primary indices used for pectus excavatum and tell us about the severity of the deformity" — Ellen Encisco (clinical) [Ep 37 · 1:12](https://library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=72)
- "The Titanic index is the percentage of the sternum that lies behind the anterior costal line as seen on CT scans" — Ellen Encisco (clinical) [Ep 37 · 1:26](https://library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=86)
- "There is a weak correlation between the Titanic index and the other indices (Haller and correction indices)" — Ellen Encisco (clinical) [Ep 37 · 1:44](https://library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=104)
- "The Titanic index might be more helpful for determining how many bars a patient will need for pectus excavatum repair" — Ellen Encisco (clinical) [Ep 37 · 1:44](https://library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=104)
- "A Titanic index threshold of 66.5% was established, with patients above this threshold probably needing more than 2 bars for repair" — Ellen Encisco (clinical) [Ep 37 · 1:55](https://library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=115)
- "The meta-analysis included 5 studies on early peritoneal dialysis after pediatric cardiac surgery" — Alex Halpern (epidemiological) [Ep 37 · 2:32](https://library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=152)
- "Early initiation of peritoneal dialysis was associated with decreased post-operative mortality in infants after cardiac surgery" — Alex Halpern (clinical) [Ep 37 · 2:35](https://library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=155)
- "Early initiation of peritoneal dialysis shortened duration of mechanical ventilation after pediatric cardiac surgery" — Alex Halpern (clinical) [Ep 37 · 2:41](https://library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=161)
- "Early initiation of peritoneal dialysis shortened length of stay in the ICU after pediatric cardiac surgery" — Alex Halpern (clinical) [Ep 37 · 2:41](https://library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=161)
- "The button battery study was a retrospective study done at Boston Children's Hospital from 2008 to 2021" — Cecilia Gigena (epidemiological) [Ep 37 · 3:16](https://library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=196)
- "The button battery study analyzed 143 patients, of whom 24 had severe outcomes" — Cecilia Gigena (epidemiological) [Ep 37 · 3:30](https://library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=210)
- "Location of the button battery in the esophagus is an independent predictor for severe outcomes" — Cecilia Gigena (clinical) [Ep 37 · 3:37](https://library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=217)
- "A button battery larger than 2 centimeters is an independent predictor for severe outcomes" — Cecilia Gigena (clinical) [Ep 37 · 3:45](https://library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=225)
- "Having symptoms at presentation is an independent predictor for severe outcomes in button battery ingestion" — Cecilia Gigena (clinical) [Ep 37 · 3:49](https://library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=229)
- "The study was a retrospective review conducted in Texas" — Cecilia Gigena (epidemiological) [Ep 38 · 0:11](https://library.globalcastmd.com/watch/impact-of-cryoanalgesia-use-during-minimally-invasive-pectus-excavatum-repair-on-hospital-days-and-total-hospital-costs-among-pediatric-patients-7862?t=11)
- "The study aimed to evaluate hospital cost and length of stay for patients undergoing minimally invasive repair of pectus excavatum plus cryoanalgesia" — Cecilia Gigena (epidemiological) [Ep 38 · 0:11](https://library.globalcastmd.com/watch/impact-of-cryoanalgesia-use-during-minimally-invasive-pectus-excavatum-repair-on-hospital-days-and-total-hospital-costs-among-pediatric-patients-7862?t=11)
- "The study included 44 patients total, with 29 undergoing cryoanalgesia" — Cecilia Gigena (epidemiological) [Ep 38 · 0:26](https://library.globalcastmd.com/watch/impact-of-cryoanalgesia-use-during-minimally-invasive-pectus-excavatum-repair-on-hospital-days-and-total-hospital-costs-among-pediatric-patients-7862?t=26)
- "Patients who underwent cryoanalgesia had significantly less length of stay compared to those without cryoanalgesia" — Cecilia Gigena (clinical) [Ep 38 · 0:26](https://library.globalcastmd.com/watch/impact-of-cryoanalgesia-use-during-minimally-invasive-pectus-excavatum-repair-on-hospital-days-and-total-hospital-costs-among-pediatric-patients-7862?t=26)
- "Patients who underwent cryoanalgesia had significantly lower complication rates compared to those without cryoanalgesia" — Cecilia Gigena (clinical) [Ep 38 · 0:26](https://library.globalcastmd.com/watch/impact-of-cryoanalgesia-use-during-minimally-invasive-pectus-excavatum-repair-on-hospital-days-and-total-hospital-costs-among-pediatric-patients-7862?t=26)
- "Patients who underwent cryoanalgesia had lower hospital costs than those without cryoanalgesia, though this difference was not statistically significant" — Cecilia Gigena (clinical) [Ep 38 · 0:39](https://library.globalcastmd.com/watch/impact-of-cryoanalgesia-use-during-minimally-invasive-pectus-excavatum-repair-on-hospital-days-and-total-hospital-costs-among-pediatric-patients-7862?t=39)
- "Cryoanalgesia helps with pain management in pectus excavatum repair" — Cecilia Gigena (opinion) [Ep 38 · 0:48](https://library.globalcastmd.com/watch/impact-of-cryoanalgesia-use-during-minimally-invasive-pectus-excavatum-repair-on-hospital-days-and-total-hospital-costs-among-pediatric-patients-7862?t=48)
- "Cryoanalgesia can help with hospital cost reduction in pectus excavatum repair" — Cecilia Gigena (opinion) [Ep 38 · 0:48](https://library.globalcastmd.com/watch/impact-of-cryoanalgesia-use-during-minimally-invasive-pectus-excavatum-repair-on-hospital-days-and-total-hospital-costs-among-pediatric-patients-7862?t=48)
- "The study is a multi-center retrospective study conducted in France describing pectus arcuatum" — Cecilia Gigena (epidemiological) [Ep 40 · 0:11](https://library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=11)
- "The study included 34 patients with pectus arcuatum" — Cecilia Gigena (epidemiological) [Ep 40 · 0:20](https://library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=20)
- "47% of patients needed chest x-ray or CT scan to confirm the diagnosis of pectus arcuatum" — Cecilia Gigena (clinical) [Ep 40 · 0:20](https://library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=20)
- "35% of pectus arcuatum patients were associated with a malformation" — Cecilia Gigena (epidemiological) [Ep 40 · 0:29](https://library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=29)
- "Noonan syndrome is an associated malformation seen with pectus arcuatum" — Cecilia Gigena (clinical) [Ep 40 · 0:29](https://library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=29)
- "Scoliosis is an associated malformation seen with pectus arcuatum" — Cecilia Gigena (clinical) [Ep 40 · 0:29](https://library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=29)
- "The best treatment for pectus arcuatum was surgical correction that included a sternotomy" — Cecilia Gigena (clinical) [Ep 40 · 0:29](https://library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=29)
- "Pectus arcuatum should not be confused with pectus carinatum as they are different conditions" — Cecilia Gigena (clinical) [Ep 40 · 0:41](https://library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=41)
- "Study period was 2011 to 2021 comparing patients who had cryoanalgesia versus those who hadn't" — Mary Brindle (clinical) [Ep 41 · 1:39](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=99)
- "44 patients total, 29 had cryoanalgesia" — Cecilia Gigena (clinical) [Ep 41 · 1:48](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=108)
- "Patients with cryoanalgesia had 3.0 days hospital stay versus 5.4 days without" — Cecilia Gigena (clinical) [Ep 41 · 1:48](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=108)
- "Hospital costs were less than $1000 difference, cheaper with cryoanesthesia" — Cecilia Gigena (clinical) [Ep 41 · 2:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=120)
- "70% decrease in complication rates with cryoanalgesia, from 33% to 17%" — Mary Brindle (clinical) [Ep 41 · 2:29](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=149)
- "Cryoanalgesia equipment is incredibly expensive" — Mary Brindle (clinical) [Ep 41 · 2:18](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=138)
- "130 lung resections performed between 2013 and 2022" — Mary Brindle (clinical) [Ep 41 · 3:48](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=228)
- "59 procedures were lobectomies (group 1), 19 diagnostic wedge resections (group 2), 52 excisional wedge resections (group 3)" (clinical) [Ep 41 · 3:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=235)
- "Patients were less than 21 years of age, exclusion criteria was spontaneous pneumothorax" — Jamie Schnuck (clinical) [Ep 41 · 4:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=252)
- "In lobectomy group, 75% had no air leak with median chest tube duration of 2 days" — Jamie Schnuck (clinical) [Ep 41 · 4:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=252)
- "In diagnostic wedge resection group, nearly 90% had no air leak with median chest tube duration of 1 day" (clinical) [Ep 41 · 4:30](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=270)
- "In excisional wedge resection group, 80% had no air leak with median chest tube duration of 1 day" (clinical) [Ep 41 · 4:39](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=279)
- "Most chest tubes were removed on the first day after surgery and majority did not have an air leak" — Jamie Schnuck (clinical) [Ep 41 · 4:48](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=288)
- "198 patients total in pilonidal disease study, divided by skin types: 21 with types 1-2, 156 with types 3-4, 21 with types 5-6" — Cecilia Gigena (clinical) [Ep 41 · 6:51](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=411)
- "151 patients had dark color hair" — Cecilia Gigena (clinical) [Ep 41 · 6:59](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=419)
- "To reach 75% hair reduction requires mean of 4.8 to 6.8 laser ablation sessions depending on skin and hair characteristics" — Cecilia Gigena (clinical) [Ep 41 · 7:34](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=454)
- "Dark hair and skin types 5-6 were associated with higher recurrence rates" — Cecilia Gigena (clinical) [Ep 41 · 7:47](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=467)
- "Overall recurrence rate was 6%" — Cecilia Gigena (clinical) [Ep 41 · 7:47](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=467)
- "Pilonidal disease study data were prospectively gathered despite being retrospective study" — Bill Chu (clinical) [Ep 41 · 6:44](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=404)
- "Laser ablation for pilonidal disease costs money and insurance coverage varies" — Mary Brindle (clinical) [Ep 41 · 8:05](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=485)
- "All three papers were chosen as PAPS Award winners at annual conference" — Mary Brindle (opinion) [Ep 41 · 8:48](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=528)
- "Pectus arcuatum is a bony deformity caused by a premature obliteration of the sternal sutures, resulting in a short sternum bent on itself" — Sahab Delaville (clinical) [Ep 42 · 2:07](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=127)
- "47% of pectus arcuatum patients required X-ray or CT scan for diagnosis" — Cecilia Gigena (clinical) [Ep 42 · 1:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=116)
- "35% of pectus arcuatum cases had associated malformations like Noonan syndrome, scoliosis, or cardiopathy" — Sahab Delaville (epidemiological) [Ep 42 · 2:40](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=160)
- "25% of pectus arcuatum patients had skeletal malformation in their family" — Sahab Delaville (epidemiological) [Ep 42 · 2:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=175)
- "Bracing does not work for pectus arcuatum treatment" — Sahab Delaville (clinical) [Ep 42 · 3:02](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=182)
- "Pectus arcuatum treatment requires surgery that includes a sternotomy" — Cecilia Gigena (clinical) [Ep 42 · 3:07](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=187)
- "Patients diagnosed with pectus arcuatum need cardiac ultrasound to look for cardiac malformation and evaluation for scoliosis" — Sahab Delaville (guideline) [Ep 42 · 3:13](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=193)
- "Early CDH repair on ECMO was defined as during the first 48 hours after ECMO cannulation" — Red Holcomb (clinical) [Ep 42 · 4:40](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=280)
- "Bleeding risk for CDH repair on ECMO was approximately 1% if operated in less than 24 hours" — Jason Smithers (clinical) [Ep 42 · 4:58](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=298)
- "Bleeding risk for CDH repair on ECMO was 5-6% at 48 hours" — Jason Smithers (clinical) [Ep 42 · 5:08](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=308)
- "Bleeding risk for CDH repair on ECMO jumped to approximately 15% after 48 hours" — Jason Smithers (clinical) [Ep 42 · 5:11](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=311)
- "Duration of ECMO support was shorter in the early CDH repair group" — Em Gootee (clinical) [Ep 42 · 5:17](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=317)
- "Survival was not statistically different between early and delayed CDH repair groups on ECMO" — Em Gootee (clinical) [Ep 42 · 5:17](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=317)
- "Some patients who only get CDH repair off ECMO die because they never came off ECMO" — Jason Smithers (clinical) [Ep 42 · 6:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=406)
- "The key after CDH repair is to get lung growth in such a way that the contralateral lung grows the most and not the ipsilateral lung" — Jason Smithers (clinical) [Ep 42 · 6:53](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=413)
- "ERAS protocols significantly reduce intraoperative fluids needed by pediatric colorectal surgery patients" — Cecilia Gigena (clinical) [Ep 42 · 7:41](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=461)
- "ERAS protocols significantly reduce postoperative opiate use in pediatric colorectal surgery" — Cecilia Gigena (clinical) [Ep 42 · 7:41](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=461)
- "Time to first oral intake was less in pediatric colorectal surgery patients with ERAS protocols" — Cecilia Gigena (clinical) [Ep 42 · 7:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=475)
- "Time for complete nutrition was less in pediatric colorectal surgery patients with ERAS protocols" — Cecilia Gigena (clinical) [Ep 42 · 7:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=475)
- "ERAS protocols have a beneficial role in accelerating rehabilitation and shortening length of hospitalization" — Red Holcomb (clinical) [Ep 42 · 8:13](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=493)
- "Physician suicide is characterized by tragically high rates of suicide among doctors compared to the general population" — Em Gootee (epidemiological) [Ep 42 · 9:32](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=572)
- "Every surgeon will have adversity in practice with patients where despite best efforts there is not a good result" — Red Holcomb (opinion) [Ep 42 · 9:47](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=587)
- "High levels of stress, emotional and physical burnout, demanding work schedules, and pressure to maintain successful careers contribute to physician suicide" — Em Gootee (clinical) [Ep 42 · 10:17](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=617)
- "Stigma associated with mental health issues within the medical profession discourages physicians from seeking help, leading to untreated depression, anxiety, and other mental health disorders" — Em Gootee (clinical) [Ep 42 · 10:33](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=633)
- "Physician mental health and suicide is discussed more now versus 10 years ago, but still should be discussed more openly" — Red Holcomb (opinion) [Ep 42 · 11:30](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=690)
- "Cryoanalgesia is a minimally invasive procedure to repair pectus excavatum or alleviate pain during surgery on the chest wall that temporarily blocks nerve conduction along peripheral nerve pathways by freezing the affected nerve" — Lizzie Lee (clinical) [Ep 46 · 0:57](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=57)
- "The freeze point is in the posterior axillary line, 4 centimeters from the vertebral column" — Lizzie Lee (clinical) [Ep 46 · 1:30](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=90)
- "With the original cryoprobe, it's a 2-minute freeze cycle" — Lizzie Lee (clinical) [Ep 46 · 1:36](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=96)
- "Cryoablation is performed from T3 to T8, although most of the literature is just to T7" — John De Fiori (clinical) [Ep 46 · 1:39](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=99)
- "Subpleural injection with 0.25% marcaine with epinephrine works immediately, as opposed to the 8 to 10 hour delay with the cryo nerve block" — Lizzie Lee (clinical) [Ep 46 · 2:02](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=122)
- "Subpleural injection takes only 15 seconds per interspace" — Lizzie Lee (clinical) [Ep 46 · 2:13](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=133)
- "50% of the update course audience has never used cryoanalgesia" — Lizzie Lee (epidemiological) [Ep 46 · 2:26](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=146)
- "About 40% of the update course responders answered that cost is the main reason they don't use cryoanalgesia" — Lizzie Lee (epidemiological) [Ep 46 · 2:33](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=153)
- "Doing T3 to T8 bilaterally with the new probe saves almost 30 minutes" — Lizzie Lee (clinical) [Ep 46 · 2:55](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=175)
- "The new probe tip gets down to temperature about 20 seconds faster" — John De Fiori (clinical) [Ep 46 · 2:59](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=179)
- "The freeze cycle with the new probe is 90 seconds instead of 2 minutes" — John De Fiori (clinical) [Ep 46 · 3:03](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=183)
- "The new probe shaft only reaches room temperature so it can touch the lung" — Lizzie Lee (clinical) [Ep 46 · 3:10](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=190)
- "A Chicago study showed that a 1 minute freeze cycle was just as effective as a 2 minute freeze cycle for nerve blocks" — John De Fiori (clinical) [Ep 46 · 3:38](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=218)
- "The Chicago study did not measure pain scores or compare the 1 minute freeze cycle directly to 2-minute freeze cycles" — Lizzie Lee (clinical) [Ep 46 · 3:48](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=228)
- "A new 10 millimeter probe with a 60 second freeze cycle is coming out on October 1st" — John De Fiori (clinical) [Ep 46 · 3:58](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=238)
- "There is a risk of pneumothorax from the lung tearing after inadvertent adhesion to the cryoprobe" — Lizzie Lee (clinical) [Ep 46 · 4:13](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=253)
- "The double lumen endotracheal tube helps minimize pneumothorax risk by deflating the lung and maximizing working space so that the cryoprobe does not touch the lung" — Lizzie Lee (clinical) [Ep 46 · 4:19](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=259)
- "A major advantage of the double lumen tube over the single lumen tube is that it helps prevent the nerve block from being done too far anteriorly, which will make the nerve block ineffective" — Lizzie Lee (clinical) [Ep 46 · 4:39](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=279)
- "Doctor Sung Kim did a cadaver study at UCSF showing that 18% of the lateral cutaneous branch nerves are posterior to the mid axillary line" — Lizzie Lee (clinical) [Ep 46 · 5:13](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=313)
- "Doctor Kim showed in the study that there is a large collateral branch of the intercostal nerve that runs along the top of the nerve, separate from the main intercostal branch on the bottom of the nerve" — John De Fiori (clinical) [Ep 46 · 5:46](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=346)
- "Doctor Defiori has done the dual freeze point technique in 20 patients anecdotally" — Lizzie Lee (clinical) [Ep 46 · 6:17](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=377)
- "The peak pain scores have dropped from about 5 to about 3 with the dual freeze point technique" — John De Fiori (clinical) [Ep 46 · 6:22](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=382)
- "98% of Doctor Defiori's patients go home the next day" — John De Fiori (clinical) [Ep 46 · 6:26](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=386)
- "In the UCSF study with 2 freeze points per interspace on 22 patients, the length of stay decreased from 2 days to 1 day" — Lizzie Lee (clinical) [Ep 46 · 6:32](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=392)
- "9 out of the 22 patients in the UCSF dual freeze point study reported pain scores of 0" — Lizzie Lee (clinical) [Ep 46 · 6:42](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=402)
- "Cryoanalgesia controls pain and decreases hospital length stay with few short-term complications" — Lizzie Lee (clinical) [Ep 46 · 7:00](https://library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=420)
- "The study was a retrospective cohort study that looked at 62 patients from 2017 to 2023" — Lizzie Lee (epidemiological) [Ep 47 · 0:19](https://library.globalcastmd.com/watch/six-years-of-quality-improvement-in-pectus-excavatum-repair-implementation-of-intercostal-nerve-cryoablation-and-eras-protocols-for-patients-undergoing-nuss-procedure-10353?t=19)
- "Intercostal nerve cryoablation significantly reduced hospital stays in pectus excavatum patients undergoing the Nuss procedure" — Lizzie Lee (clinical) [Ep 47 · 0:25](https://library.globalcastmd.com/watch/six-years-of-quality-improvement-in-pectus-excavatum-repair-implementation-of-intercostal-nerve-cryoablation-and-eras-protocols-for-patients-undergoing-nuss-procedure-10353?t=25)
- "Intercostal nerve cryoablation significantly reduced opioid use in pectus excavatum patients undergoing the Nuss procedure" — Lizzie Lee (clinical) [Ep 47 · 0:25](https://library.globalcastmd.com/watch/six-years-of-quality-improvement-in-pectus-excavatum-repair-implementation-of-intercostal-nerve-cryoablation-and-eras-protocols-for-patients-undergoing-nuss-procedure-10353?t=25)
- "Intercostal nerve cryoablation slightly increased surgery time in pectus excavatum patients undergoing the Nuss procedure" — Lizzie Lee (clinical) [Ep 47 · 0:25](https://library.globalcastmd.com/watch/six-years-of-quality-improvement-in-pectus-excavatum-repair-implementation-of-intercostal-nerve-cryoablation-and-eras-protocols-for-patients-undergoing-nuss-procedure-10353?t=25)
- "Intercostal nerve cryoablation slightly increased early postoperative pain in pectus excavatum patients undergoing the Nuss procedure" — Lizzie Lee (clinical) [Ep 47 · 0:25](https://library.globalcastmd.com/watch/six-years-of-quality-improvement-in-pectus-excavatum-repair-implementation-of-intercostal-nerve-cryoablation-and-eras-protocols-for-patients-undergoing-nuss-procedure-10353?t=25)
- "Adding ERAS protocols to cryoablation further reduced opioid needs in pectus excavatum patients undergoing the Nuss procedure" — Lizzie Lee (clinical) [Ep 47 · 0:36](https://library.globalcastmd.com/watch/six-years-of-quality-improvement-in-pectus-excavatum-repair-implementation-of-intercostal-nerve-cryoablation-and-eras-protocols-for-patients-undergoing-nuss-procedure-10353?t=36)
- "Adding ERAS protocols to cryoablation further reduced early pain scores in pectus excavatum patients undergoing the Nuss procedure" — Lizzie Lee (clinical) [Ep 47 · 0:36](https://library.globalcastmd.com/watch/six-years-of-quality-improvement-in-pectus-excavatum-repair-implementation-of-intercostal-nerve-cryoablation-and-eras-protocols-for-patients-undergoing-nuss-procedure-10353?t=36)
- "Combining cryoablation and ERAS protocols leads to better outcomes and pain management in pectus excavatum patients undergoing the Nuss procedure" — Lizzie Lee (opinion) [Ep 47 · 0:40](https://library.globalcastmd.com/watch/six-years-of-quality-improvement-in-pectus-excavatum-repair-implementation-of-intercostal-nerve-cryoablation-and-eras-protocols-for-patients-undergoing-nuss-procedure-10353?t=40)
- "The study was a single institution retrospective chart review conducted from 2012 to 2023" — Alex Halpern (clinical) [Ep 48 · 0:13](https://library.globalcastmd.com/watch/vacuum-bell-therapy-for-pectus-excavatum-long-term-experience-at-a-single-center-10404?t=13)
- "278 patients were included in the analysis" — Alex Halpern (epidemiological) [Ep 48 · 0:20](https://library.globalcastmd.com/watch/vacuum-bell-therapy-for-pectus-excavatum-long-term-experience-at-a-single-center-10404?t=20)
- "31 patients had excellent corrections with vacuum bell therapy" — Alex Halpern (clinical) [Ep 48 · 0:23](https://library.globalcastmd.com/watch/vacuum-bell-therapy-for-pectus-excavatum-long-term-experience-at-a-single-center-10404?t=23)
- "247 patients had non-excellent corrections with vacuum bell therapy" — Alex Halpern (clinical) [Ep 48 · 0:23](https://library.globalcastmd.com/watch/vacuum-bell-therapy-for-pectus-excavatum-long-term-experience-at-a-single-center-10404?t=23)
- "Initial chest depth less than 1.5 centimeters is a predictor of positive outcomes" — Alex Halpern (clinical) [Ep 48 · 0:29](https://library.globalcastmd.com/watch/vacuum-bell-therapy-for-pectus-excavatum-long-term-experience-at-a-single-center-10404?t=29)
- "Chest wall flexibility is a predictor of positive outcomes" — Alex Halpern (clinical) [Ep 48 · 0:29](https://library.globalcastmd.com/watch/vacuum-bell-therapy-for-pectus-excavatum-long-term-experience-at-a-single-center-10404?t=29)
- "Excellent correction was more common in children 8 to 12.9 years old" — Alex Halpern (clinical) [Ep 48 · 0:29](https://library.globalcastmd.com/watch/vacuum-bell-therapy-for-pectus-excavatum-long-term-experience-at-a-single-center-10404?t=29)
- "Excellent correction in children with pectus excavatum treated with vacuum bell therapy is uncommon" — Alex Halpern (opinion) [Ep 48 · 0:41](https://library.globalcastmd.com/watch/vacuum-bell-therapy-for-pectus-excavatum-long-term-experience-at-a-single-center-10404?t=41)
- "Improved outcomes are seen in younger patients with more mild defects and greater chest wall flexibility" — Alex Halpern (clinical) [Ep 48 · 0:41](https://library.globalcastmd.com/watch/vacuum-bell-therapy-for-pectus-excavatum-long-term-experience-at-a-single-center-10404?t=41)
- "This was a prospective pilot study" — Lizzie Lee (clinical) [Ep 49 · 0:12](https://library.globalcastmd.com/watch/cardiopulmonary-impact-of-the-minimally-invasive-repair-of-pectus-excavatum-in-pediatric-patients-a-prospective-pilot-study-10436?t=12)
- "Study included patients under 18 who had cardiopulmonary exercise testing before minimally invasive repair of pectus excavatum and then after removal of their pectus bar" — Lizzie Lee (clinical) [Ep 49 · 0:12](https://library.globalcastmd.com/watch/cardiopulmonary-impact-of-the-minimally-invasive-repair-of-pectus-excavatum-in-pediatric-patients-a-prospective-pilot-study-10436?t=12)
- "25 patients total completed both tests" — Lizzie Lee (clinical) [Ep 49 · 0:24](https://library.globalcastmd.com/watch/cardiopulmonary-impact-of-the-minimally-invasive-repair-of-pectus-excavatum-in-pediatric-patients-a-prospective-pilot-study-10436?t=24)
- "Results showed a significant improvement in O2 pulse after the repair" — Lizzie Lee (clinical) [Ep 49 · 0:24](https://library.globalcastmd.com/watch/cardiopulmonary-impact-of-the-minimally-invasive-repair-of-pectus-excavatum-in-pediatric-patients-a-prospective-pilot-study-10436?t=24)
- "O2 pulse is a measure of how much oxygen the heart pumps per beat" — Lizzie Lee (clinical) [Ep 49 · 0:24](https://library.globalcastmd.com/watch/cardiopulmonary-impact-of-the-minimally-invasive-repair-of-pectus-excavatum-in-pediatric-patients-a-prospective-pilot-study-10436?t=24)
- "Improved O2 pulse suggests better heart function after the repair" — Lizzie Lee (clinical) [Ep 49 · 0:24](https://library.globalcastmd.com/watch/cardiopulmonary-impact-of-the-minimally-invasive-repair-of-pectus-excavatum-in-pediatric-patients-a-prospective-pilot-study-10436?t=24)
- "The improvement may reflect relief of cardiac compression that was present preoperatively due to pectus excavatum" — Lizzie Lee (opinion) [Ep 49 · 0:37](https://library.globalcastmd.com/watch/cardiopulmonary-impact-of-the-minimally-invasive-repair-of-pectus-excavatum-in-pediatric-patients-a-prospective-pilot-study-10436?t=37)
- "Minimally invasive repair of pectus excavatum does appear to improve heart performance during exercise" — Lizzie Lee (clinical) [Ep 49 · 0:43](https://library.globalcastmd.com/watch/cardiopulmonary-impact-of-the-minimally-invasive-repair-of-pectus-excavatum-in-pediatric-patients-a-prospective-pilot-study-10436?t=43)
- "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 50 · 2:17](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=137)
- "90% of patients showed complete airway collapse on dynamic bronchoscopy" — George W. Holcomb III (clinical) [Ep 50 · 2:34](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=154)
- "Three-quarters of tracheobronchopexy procedures used a posterior approach" — George W. Holcomb III (clinical) [Ep 50 · 2:40](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=160)
- "Over half of procedures involved thoracic trachea alone, but 40% required extension onto the bronchi" — George W. Holcomb III (clinical) [Ep 50 · 2:44](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=164)
- "94% of patients avoided tracheostomy with a mortality rate of 5%" — George W. Holcomb III (clinical) [Ep 50 · 2:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=177)
- "Tracheobronchopexy significantly reduced pressure ventilation and ventilator dependence" — George W. Holcomb III (clinical) [Ep 50 · 2:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=177)
- "Canada's population is smaller than California but it is the second largest country in the world geographically" — Eric Skarsgard (epidemiological) [Ep 50 · 5:28](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=328)
- "The majority of Canada's population lives within 200 kilometers of the US border" — Eric Skarsgard (epidemiological) [Ep 50 · 5:38](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=338)
- "Outreach services were present in only 7 out of 10 provinces in Canada" — Preet Bir (epidemiological) [Ep 50 · 6:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=403)
- "Only 8 out of 18 children's hospitals (44%) provided outreach services" — Preet Bir (epidemiological) [Ep 50 · 6:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=403)
- "A significant number of outreach services are located within 50 kilometers of a children's hospital" — Em Gootee (epidemiological) [Ep 50 · 6:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?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 50 · 7:36](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=456)
- "The Canadian healthcare system does not ensure timely care; children wait for surgery beyond their wait time target" — Eric Skarsgard (clinical) [Ep 50 · 8:01](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=481)
- "Newfoundland and Labrador has only two pediatric surgeons but has the most well-established outreach clinic system in Canada" — Eric Skarsgard (epidemiological) [Ep 50 · 8:16](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=496)
- "5% of all pediatric procedures in the NSQIP database were G-tube placements" — Sean Kunisaki (epidemiological) [Ep 50 · 11:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=716)
- "The study analyzed 4,612 G-tube placements from 71 NSQIP-Pediatric hospitals in 2023" — Em Gootee (epidemiological) [Ep 50 · 12:42](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=762)
- "77% of G-tube cases were first-time placements as opposed to redos" — Anusha Maturu / Derek Wakeman (epidemiological) [Ep 50 · 12:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=766)
- "Upper GI studies were obtained in 45% of first-time G-tube cases" — Em Gootee (clinical) [Ep 50 · 13:04](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=784)
- "Interhospital variability in upper GI use ranged from 0 to 99%" — Em Gootee (clinical) [Ep 50 · 13:04](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=784)
- "14% of G-tube cases resulted in an ED visit within 0 to 30 days" — Em Gootee (clinical) [Ep 50 · 13:45](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=825)
- "5.2% of G-tubes were dislodged within 0 to 30 days" — Em Gootee (clinical) [Ep 50 · 13:45](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=825)
- "An additional 5.5% of G-tubes were dislodged in the 31 to 60 day period" — Anusha Maturu / Derek Wakeman (clinical) [Ep 50 · 13:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=835)
- "Dislodgement rates are higher than readmission rates or IR intervention rates" — Anusha Maturu / Derek Wakeman (clinical) [Ep 50 · 13:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=835)
- "If dislodgements can be reduced, ED visits will decrease correspondingly" — Anusha Maturu / Derek Wakeman (opinion) [Ep 50 · 14:15](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=855)
- "Cross-training occurs at Cincinnati Children's with interventional radiologists teaching pediatric surgery fellows ultrasound guidance for vascular access" (clinical) [Ep 51 · 0:53](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=53)
- "Hybrid OR collaboration can occur in regular OR by bringing in an ultrasound machine without requiring a dedicated hybrid OR" (clinical) [Ep 51 · 1:02](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=62)
- "Cone beam CT is performed on a C-arm fluoroscopy unit that rotates around the patient collecting multiple images stacked together to create a CT" (clinical) [Ep 51 · 1:25](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=85)
- "ChatGPT can screen thousands of articles in systematic review based on title and abstract with explanation column for decision rationale" (clinical) [Ep 51 · 2:20](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=140)
- "Jenny AI can provide relevant answers, cite supporting papers, and format citations according to preferred style" (clinical) [Ep 51 · 3:27](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=207)
- "Double lumen endotracheal tube deflates the lung on the side of cryoablation for thoracoscopic guidance" (clinical) [Ep 51 · 4:35](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=275)
- "Cryoanalgesia targets T3 to T8 with 2-minute freeze cycles per interspace" (clinical) [Ep 51 · 4:46](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=286)
- "Subpleural injection with 0.25% marcaine with epinephrine works immediately versus 8-10 hour delay with cryo nerve block" (clinical) [Ep 51 · 4:56](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=296)
- "Double lumen endotracheal tube reduces risk of pneumothorax during cryoanalgesia" (clinical) [Ep 51 · 5:09](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=309)
- "Cryoanalgesia blocks fail when surgeons use single lumen tube and perform block too far anteriorly" (clinical) [Ep 51 · 5:13](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=313)
- "Majority of centers still do VA ECMO primarily for CDH babies" (epidemiological) [Ep 51 · 6:34](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=394)
- "Michigan SER Protocol showed survival was equivalent between ECMO and comfort care groups for severe unilateral CDH based on prenatal criteria" (clinical) [Ep 51 · 6:43](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=403)
- "With biovalrudin ECMO management, surgical repair can proceed after 8 hours once levels are stable" (clinical) [Ep 51 · 7:26](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=446)
- "Early repair while on ECMO is safe with optimal window between 8 to 24 hours" (clinical) [Ep 51 · 7:49](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=469)
- "CO2 laser operates in spectrum of 920 to 1400 nm which is well absorbed by water" (clinical) [Ep 51 · 8:14](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=494)
- "CO2 laser circumcision using sleeve technique with dorsal slit and cyanoacrylate adhesive had 3% complication rate in 56 cases" (clinical) [Ep 51 · 8:30](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=510)
- "CO2 laser frenulectomy in 47 patients showed low pain profile with no suture required" (clinical) [Ep 51 · 8:40](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=520)
- "Autofluorescence in randomized controlled trial from France reduced rates of hypoparathyroidism and hypocalcemia following thyroidectomy" (clinical) [Ep 51 · 9:37](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=577)
- "Parathyroids naturally autofluoresce at specific wavelength without injection" (clinical) [Ep 51 · 9:53](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=593)
- "Hypocalcemia rates were about 50% lower with autofluorescence use versus not using it" (clinical) [Ep 51 · 10:07](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=607)
- "Surgery-first pathway for pediatric cholelithiasis reduces resource utilization including MRCP" (clinical) [Ep 51 · 11:33](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=693)
- "ERCP causes pancreatitis 10% of the time regardless of operator skill" (clinical) [Ep 51 · 12:02](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=722)
- "Stone clearance rate reflected by negative intraoperative cholangiogram was 86% with surgery-first approach" (clinical) [Ep 51 · 12:14](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=734)
- "Success rate was in the 90s with simple flushing or catheter manipulation of common bile duct or reaming the sphincter" (clinical) [Ep 51 · 12:25](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=745)
- "Every 10 day delay in biliary atresia treatment worsens outcomes by 20% according to Midwest study data" (epidemiological) [Ep 51 · 13:41](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=821)
- "MMP-7 sensitivity is pretty good but cutoffs vary between teams because the assay is still evolving" (clinical) [Ep 51 · 13:58](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=838)
- "Cincinnati Children's commitment is Kasai procedure within 7 days of biliary atresia patient presentation" (guideline) [Ep 51 · 14:21](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=861)
- "REBOA can be performed in pediatric patients but is rarely done with no clear survival advantage over laparotomy" (clinical) [Ep 51 · 15:48](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=948)
- "Patients presenting with wounds as initial presentation for pilonidal tend to not always reach full healing with minimally invasive approach" (clinical) [Ep 51 · 16:23](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=983)
- "US Army clinic with captive patient population implementing weekly shaving protocol observed dramatic improvement and significantly reduced need for surgical intervention in pilonidal disease" (clinical) [Ep 51 · 16:40](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=1000)
- "Clipping is probably the easiest and simplest approach for pilonidal disease hair removal when parent or active caregiver is involved, recommended once weekly" (clinical) [Ep 51 · 17:17](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=1037)
- "Cryoanalgesia temporarily blocks nerve conduction along peripheral nerve pathways by freezing the affected nerve" — Lizzie Lee (clinical) [Ep 52 · 1:02](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=62)
- "The freeze causes axonal degeneration while the epineurium stays intact" — Timothy Lotz (clinical) [Ep 52 · 1:19](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=79)
- "When fibrous outer neural structures remain intact, axons can regenerate in 4 to 6 weeks" — Lizzie Lee (clinical) [Ep 52 · 1:25](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=85)
- "Very few people do intercostal nerve cryoablation for pain control during thoracotomy, based on poll results from combined live and virtual audience" — Lizzie Lee (epidemiological) [Ep 52 · 1:39](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=99)
- "Epidurals usually only give pain relief for a few days" — Lizzie Lee (clinical) [Ep 52 · 1:57](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=117)
- "Cryoanalgesia can help with pain control all through the recovery period" — Lizzie Lee (clinical) [Ep 52 · 1:57](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=117)
- "The team has done 300 thoracotomy cases with cryoanalgesia and seen great results" — Timothy Lotz (epidemiological) [Ep 52 · 2:10](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=130)
- "Cryoanalgesia is applied 1 to 2 levels above and below the thoracotomy" — Timothy Lotz (clinical) [Ep 52 · 2:17](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=137)
- "At T10 level or lower, you can start to get pseudohernias on the abdominal wall from affecting the motor branches" — Lizzie Lee (clinical) [Ep 52 · 2:23](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=143)
- "60 seconds of freeze time is sufficient" — Timothy Lotz (clinical) [Ep 52 · 2:32](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=152)
- "Temporary intercostal nerve blocks are used to help for the first 8 hours before cryoanalgesia sets in" — Timothy Lotz (clinical) [Ep 52 · 2:33](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=153)
- "Standard probe is used down to age 3, with cases done in kids as young as 18 months" — Timothy Lotz (clinical) [Ep 52 · 2:39](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=159)
- "A cardiac probe is used for ablations in smaller children" — Lizzie Lee (clinical) [Ep 52 · 2:44](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=164)
- "In smaller children, retractors are used to hold skin away because there is not much chest wall musculature and skin freeze could occur" — Timothy Lotz (clinical) [Ep 52 · 2:52](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=172)
- "The newest probe has shaft insulation that only gets to room temperature, eliminating skin freeze risk because only the probe tip gets cold" — Lizzie Lee (clinical) [Ep 52 · 2:58](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=178)
- "Benefits include no epidural, no Foley catheter, and patients getting up and moving right away" — Timothy Lotz (clinical) [Ep 52 · 3:09](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=189)
- "Pulmonary toilet has been great with cryoanalgesia" — Timothy Lotz (clinical) [Ep 52 · 3:13](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=193)
- "Comparison in the group showed a 2 to 3-fold reduction in narcotic use during hospitalization" — Timothy Lotz (epidemiological) [Ep 52 · 3:15](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=195)
- "Kids were sent home without any narcotic prescriptions" — Lizzie Lee (clinical) [Ep 52 · 3:21](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=201)
- "You don't have to wait for a regional team when using cryoanalgesia" — Lizzie Lee (clinical) [Ep 52 · 3:24](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=204)
- "The study compared results to a routine group with IV pain medication only and to those with regional block" — Timothy Lotz (epidemiological) [Ep 52 · 3:29](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=209)
- "The study included 23 thoracotomies with cryoanalgesia" — Timothy Lotz (epidemiological) [Ep 52 · 3:37](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=217)
- "The cryoablation group used dramatically fewer oral morphine equivalents during hospital stay compared to the regional nerve block group" — Lizzie Lee (epidemiological) [Ep 52 · 3:40](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=220)
- "Cryoanalgesia group used 137 oral morphine equivalents versus 533 in the comparison group" — Timothy Lotz (epidemiological) [Ep 52 · 3:50](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=230)
- "The team uses cryoanalgesia all the time for thoracotomies, other than neonatal thoracotomies" — Timothy Lotz (clinical) [Ep 52 · 3:50](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=230)
- "Cryoablation is not limited to just thoracotomy or thoracoscopy" — Lizzie Lee (clinical) [Ep 53 · 0:56](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=56)
- "There are novel ways to use cryotherapy in a percutaneous approach" — Lizzie Lee (clinical) [Ep 53 · 1:00](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=60)
- "Cryoablation shows real benefits for rib fractures, slipping rib syndrome, and other endochondromas" — Thomas Inge (clinical) [Ep 53 · 1:12](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=72)
- "Slipping rib syndrome is a condition with cartilaginous union at the end of the ribs, for floating ribs in particular, but also for false ribs" — Lizzie Lee (clinical) [Ep 53 · 1:21](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=81)
- "Laxity in costochondral junctions causes impingement on intercostal nerves as the ribs slip and float" — Thomas Inge (clinical) [Ep 53 · 1:28](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=88)
- "Slipping rib syndrome can be the cause of chronic abdominal wall pain" — Thomas Inge (clinical) [Ep 53 · 1:30](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=90)
- "Patients with slipping rib syndrome may have already had their appendix or gallbladder removed without arriving at the right diagnosis" — Thomas Inge (clinical) [Ep 53 · 1:44](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=104)
- "Slipping rib syndrome is more common in teenage girls than boys" — Lizzie Lee (epidemiological) [Ep 53 · 1:58](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=118)
- "Patients with slipping rib syndrome often present with somatic tenderness of the abdominal wall that can be elicited by asking them to flex or crunch their abdominal muscles" — Lizzie Lee (clinical) [Ep 53 · 2:01](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=121)
- "Patients with slipping rib syndrome really won't have a visceral type tenderness" — Lizzie Lee (clinical) [Ep 53 · 2:01](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=121)
- "The usual approach for patients with slipping rib syndrome is to refer them to chronic pain" — Thomas Inge (clinical) [Ep 53 · 2:12](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=132)
- "Chronic pain can do an evaluation and do an intercostal block, usually a steroid as well as a long acting local" — Thomas Inge (clinical) [Ep 53 · 2:17](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=137)
- "If patients get pain relief from the intercostal block with ropivacaine and dexamethasone, the next step is to refer them to interventional radiology for ultrasound guided cryotherapy" — Lizzie Lee (clinical) [Ep 53 · 2:25](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=145)
- "If there's an actual response to intercostal block, the next step is to refer to surgery" — Thomas Inge (clinical) [Ep 53 · 2:34](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=154)
- "IR performs ablation at just the right level or more commonly multiple levels" — Thomas Inge (clinical) [Ep 53 · 2:44](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=164)
- "Cryoablation can be used intraoperatively in combination with surgery to remove the rib tips or to stabilize a slipping cartilaginous costal margin" — Thomas Inge (clinical) [Ep 53 · 3:01](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=181)
- "Outcomes from using cryoablation for slipping rib syndrome included reduced pain scores" — Lizzie Lee (clinical) [Ep 53 · 3:13](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=193)
- "Outcomes from using cryoablation for slipping rib syndrome included reduced narcotic use" — Lizzie Lee (clinical) [Ep 53 · 3:13](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=193)
- "Outcomes from using cryoablation for slipping rib syndrome included shorter length of stay in the hospital" — Lizzie Lee (clinical) [Ep 53 · 3:13](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=193)
- "Patients were able to resume normal activities much earlier after cryoablation for slipping rib syndrome" — Lizzie Lee (clinical) [Ep 53 · 3:19](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=199)
- "If you have someone come in with chest or fractures that gets stuck on a ventilator, you can do a world of good with cryoablation by anesthetizing just those intercostal spaces that are the problem" — Thomas Inge (clinical) [Ep 53 · 3:27](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=207)
- "IR colleagues use the same needles for cryoablating liver lesions and lung nodules that can be applied to intercostal nerve ablation" (clinical) [Ep 53 · 3:55](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=235)
- "About 30% of Don's practice consists of revision pectus cases, not all his own primary repairs." — Don (clinical) [Ep 3 · 1:01](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=61)
- "True recurrence incidence after pectus repair is unknown because many patients do not report back to centers." — Don (epidemiological) [Ep 3 · 1:20](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=80)
- "In a UCLA adult open repair series with reported 5% recurrence, at least 20 patients contacted Don over 10 years wanting revision for recurrence." — Don (clinical) [Ep 3 · 1:50](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=110)
- "Nuss revision failures are typically due to technical issues: bar positioning, bar rotation, and premature removal." — Don (clinical) [Ep 3 · 2:23](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=143)
- "Open repair failures involve different mechanisms: healing issues, malunion, and regression." — Don (clinical) [Ep 3 · 2:33](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=153)
- "Once Nuss bars rotate, their ability to elevate the chest wall is lost and they usually cause pain." — Don (clinical) [Ep 3 · 3:25](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=205)
- "Lateral stripping of Nuss bars is the most common problem Don sees in adults; the bar migrates posteriorly inside the chest, losing forward elevation." — Don (clinical) [Ep 3 · 3:44](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=224)
- "In adult pectus, the chest is often so stiff and rigid that intercostal spaces cannot support bar pressure, leading to rib spreading and bar drop-in." — Don (clinical) [Ep 3 · 4:52](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=292)
- "Don uses forced sternal elevation, intercostal space reinforcement, medial bar fixation, multiple bars, and releasing osteotomies as revision strategies." — Don (clinical) [Ep 3 · 5:22](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=322)
- "The Roux retractor (rule track) is a bone clamp attached to the sternum that lifts and elevates the chest during dissection, creating open space for bar passage." — Don (clinical) [Ep 3 · 6:05](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=365)
- "Don now uses the Roux retractor on all cases for safety and ease, not just complicated ones." — Don (opinion) [Ep 3 · 6:48](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=408)
- "FiberWire (woven PTFE suture) is used in figure-of-eight around ribs and bar to prevent rib separation and bar drop-in." — Don (clinical) [Ep 3 · 7:04](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=424)
- "About 30% of Don's patients now receive three bars to balance pressure and reduce pain in heavier, stiffer chests." — Don (clinical) [Ep 3 · 7:44](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=464)
- "Don uses FiberWire sutures (not stabilizers) to catch at least three ribs, and for low bars drills through the sternum to loop suture around sternum and bar to prevent rotation." — Don (clinical) [Ep 3 · 8:02](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=482)
- "In adults under 30, almost all patients could be elevated with the Roux retractor and Lorenz dissector; only a couple could not lift." — Don (clinical) [Ep 3 · 19:14](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1154)
- "In adults over 30, 88.7% could be elevated with forced techniques, but 11-12% would not lift and required osteotomies." — Don (clinical) [Ep 3 · 19:28](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1168)
- "If the chest does not lift with forced elevation, bars alone will not make it lift—they are not strong enough." — Don (clinical) [Ep 3 · 20:33](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1233)
- "Don performs a mini-osteotomy by making small incisions and freeing cartilages from the sternum at sites that do not lift, then shortening cartilages to allow reapproximation." — Don (clinical) [Ep 3 · 20:52](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1252)
- "Don now places small plates across osteotomy sites to prevent cosmetic knobbing and achieve better healing." — Don (clinical) [Ep 3 · 23:13](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1393)
- "In older patients with calcified cartilage, the cartilage-sparing perichondrial technique is often not feasible; a slicing osteotomy and segment removal is required." — Don (clinical) [Ep 3 · 24:39](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1479)
- "Osteotomies must be done open; thoracoscopic cartilage removal is possible but very difficult and requires stabilization with sutures or plates." — Don (opinion) [Ep 3 · 26:01](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1561)
- "Redo open repairs fall into three categories: those that fell in without support (can re-Nuss), those that are fixed (require osteotomies), and disasters with chest wall holes and malunion." — Don (clinical) [Ep 3 · 30:15](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1815)
- "Patients with evidence of hernia, malunion, or thoracic dystrophy automatically require open repair." — Don (clinical) [Ep 3 · 30:42](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1842)
- "Don preps all redo open cases with groins exposed in case life-threatening bleeding occurs, allowing femoral bypass access." — Don (clinical) [Ep 3 · 31:40](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1900)
- "Don plates all redo open cases anteriorly in addition to posterior bars, because early experience showed recurrence after bar-only support." — Don (clinical) [Ep 3 · 31:54](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1914)
- "Malunion or pseudoarthrosis is best assessed by physical exam; CT scans may not fully reveal the extent of instability." — Don (clinical) [Ep 3 · 33:05](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1985)
- "Patients with malunion can have near-normal Haller index but severe symptoms: pain, inability to Valsalva, and paradoxical chest wall movement." — Don (clinical) [Ep 3 · 33:53](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=2033)
- "Reconstruction of malunion requires stabilization with plating, often bone graft or methylmethacrylate to fill spaces, and sometimes mesh." — Don (clinical) [Ep 3 · 34:16](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=2056)
- "In thin patients with atrophied pectoralis muscles, biologic mesh is placed over plates to ensure soft tissue coverage and prevent exposure." — Don (clinical) [Ep 3 · 35:32](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=2132)
- "Methylmethacrylate can be used to fashion and recreate lower chest wall segments that have necrosed out, secured with plating." — Don (clinical) [Ep 3 · 37:15](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=2235)
- "Chronic pain is a big problem in revision cases; stabilizing and fixing sometimes resolves pain, but not always." — Don (clinical) [Ep 3 · 39:25](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=2365)
- "A patient with expiratory chest wall collapse had a Haller index of 2.2 on inspiration but 5.0 on expiration, with lung herniating through the chest wall." — Don (clinical) [Ep 3 · 40:07](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=2407)
- "Revision patients are never completely normal again; the best goal is to make them better." — Don (opinion) [Ep 3 · 41:28](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=2488)
- "If bars are placed and then removed with subsequent collapse, there are underlying issues that must be addressed before further bar placement." — Don (clinical) [Ep 3 · 42:05](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=2525)
- "In patients with connective tissue disorders or chests that will not heal, repeated operations can lead to infections, osteonecrosis, and a cycle of chasing problems." — Don (clinical) [Ep 3 · 42:28](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=2548)
- "The best operation is the first operation; correct execution initially is critical to avoid revision complications." — Garcia (opinion) [Ep 3 · 43:20](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=2600)
- "The Nuss procedure has a significant learning curve and is not a see-one-do-one operation." — Garcia (opinion) [Ep 3 · 43:49](https://library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=2629)
- "Nothing is as good as epidural analgesia for pectus patients; On-Q pumps come second to epidural in Cincinnati's experience" — Central Sadai (opinion) [Ep 8 · 0:29](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=29)
- "More than 95% of Cincinnati pectus patients do not get a PCA along with epidural" — Central Sadai (clinical) [Ep 8 · 1:28](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=88)
- "More than 99% of Cincinnati pectus patients get epidural analgesia" — Central Sadai (clinical) [Ep 8 · 2:04](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=124)
- "Pain catastrophization (anticipating negative outcomes) is associated with more postoperative pain" — Central Sadai (clinical) [Ep 8 · 3:29](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=209)
- "The two major risks with epidural are injury during placement and infection (epidural abscess) if catheter left too long" — Central Sadai (clinical) [Ep 8 · 4:25](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=265)
- "Cincinnati removes epidural catheters on the 3rd day after surgery to minimize infection risk" — Central Sadai (clinical) [Ep 8 · 5:24](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=324)
- "Most neurological risk with epidural in children is from hypoperfusion of spinal cord, not traumatic placement" — Central Sadai (clinical) [Ep 8 · 5:30](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=330)
- "On-Q catheter effectiveness depends on multiple factors: delivery amount, location, catheter size (5cm vs 7.5cm), and introducer diameter" — Don (clinical) [Ep 8 · 7:59](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=479)
- "The 7.5cm On-Q catheter is much better than the 5cm catheter which is too short to cover the area" — Don (clinical) [Ep 8 · 8:10](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=490)
- "Exparel (liposomal bupivacaine) is safer than plain local anesthetic because the treatment for local anesthetic toxicity is intralipid, which Exparel already contains" — Central Sadai (clinical) [Ep 8 · 10:32](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=632)
- "Exparel is not FDA-approved for pediatric use" — Central Sadai (guideline) [Ep 8 · 11:01](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=661)
- "Cincinnati allows patients with epidural to walk inside the room and outside with help because there is no narcotic in the epidural solution" — Central Sadai (clinical) [Ep 8 · 12:05](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=725)
- "Cincinnati has three different pain services, one dedicated to surgical pain that manages all surgical patients including pectus" — Central Sadai (clinical) [Ep 8 · 13:52](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=832)
- "The surgical pain service sees patients minimum 3 times daily: morning, afternoon, and evening rounds" — Central Sadai (clinical) [Ep 8 · 14:12](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=852)
- "About 20-30% of pectus patients experience chronic persistent post-operative pain (CPSP), defined as pain score of 3 or more at two months after surgery" — Central Sadai (epidemiological) [Ep 8 · 18:00](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1080)
- "If a child is on 5 days in a row of oxycodone or any other opioid, the risk of dependence goes up significantly" — Central Sadai (clinical) [Ep 8 · 19:50](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1190)
- "The advantage of opioids in epidural solution is very minimal; it causes more problems (itching, urinary retention) than benefit" — Central Sadai (opinion) [Ep 8 · 32:02](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1922)
- "Cincinnati uses high concentration ropivacaine 0.2% in epidural; lower concentrations (0.12% or 0.15%) don't provide adequate pain relief" — Central Sadai (clinical) [Ep 8 · 32:22](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1942)
- "Mark Saxton reported 1 in 7 patients need catheterization for urinary retention when Foley catheters are not placed" (clinical) [Ep 8 · 34:11](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=2051)
- "About 50% of patients get constipation the moment oxycodone is started" — Central Sadai (clinical) [Ep 8 · 35:14](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=2114)
- "Naloxegol relieves opioid-induced constipation without reversing analgesic effects because it doesn't cross the blood-brain barrier" — Central Sadai (clinical) [Ep 8 · 35:25](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=2125)
- "About 15% of spine surgery patients on PCA have respiratory depression (respiratory rate <8 breaths/minute and saturation <90%) despite multimodal analgesia" — Central Sadai (clinical) [Ep 8 · 37:13](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=2233)
- "About 80-85% of the population are intermediate or extensive metabolizers of tramadol; 10-12% are poor metabolizers who don't get good pain relief; 1-2% are ultra-rapid metabolizers at risk for respiratory depression and death" — Central Sadai (clinical) [Ep 8 · 38:03](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=2283)
- "In Ethiopian populations, ultra-rapid metabolizers can be as high as 29%" — Central Sadai (epidemiological) [Ep 8 · 49:45](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=2985)
- "The FDA has warned against use of codeine following tonsillectomy; warnings for tramadol and hydrocodone are under FDA review" — Central Sadai (guideline) [Ep 8 · 50:00](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=3000)
- "Among currently available opioids, oxycodone is the least affected by CYP2D6 metabolism" — Central Sadai (clinical) [Ep 8 · 50:13](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=3013)
- "Sedation always precedes respiratory depression" — Central Sadai (clinical) [Ep 8 · 51:29](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=3089)
- "Cincinnati has not used naloxone for any pain patients in more than three years" — Central Sadai (clinical) [Ep 8 · 52:02](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=3122)
- "The 50-gene genetic panel costs $50; CYP2D6 testing costs less than $1 per gene" — Central Sadai (clinical) [Ep 8 · 52:23](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=3143)
- "Genetic testing for high-risk patients saves more than $100 per patient through targeted interventions" — Central Sadai (clinical) [Ep 8 · 52:42](https://library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=3162)
- "Nothing is as good as epidural analgesia for pectus patients; On-Q pumps come second in the speaker's experience" — Central Sadai (opinion) [Ep 13 · 0:29](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=29)
- "More than 95% of Cincinnati pectus patients do not receive PCA along with epidural" — Central Sadai (clinical) [Ep 13 · 1:28](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=88)
- "More than 99% of Cincinnati pectus patients receive epidural analgesia" — Central Sadai (clinical) [Ep 13 · 2:20](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=140)
- "Pain catastrophizing (anticipating negative outcomes) is associated with more postoperative pain in children and parents" — Central Sadai (clinical) [Ep 13 · 3:29](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=209)
- "Two major risks with epidural are injury during placement (including paraplegia) and infection (epidural abscess) if catheter left too long" — Central Sadai (clinical) [Ep 13 · 4:25](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=265)
- "Most neurological injury from epidural in children is from hypoperfusion of spinal cord, not traumatic placement" — Central Sadai (clinical) [Ep 13 · 5:30](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=330)
- "Cincinnati removes epidural catheters on the 3rd day after surgery to minimize infection risk" — Central Sadai (clinical) [Ep 13 · 5:24](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=324)
- "On-Q catheter introducer that is wider than the track causes backflow leak and reduces permeation effectiveness" — Don (clinical) [Ep 13 · 8:13](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=493)
- "Most On-Q data in thoracic surgery is from thoracotomy with subpleural tunneling, making extrapolation to pectus difficult" — Don (clinical) [Ep 13 · 8:25](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=505)
- "Liposomal bupivacaine (Exparel) is safer than plain local anesthetic because it is formulated in intralipid, which is the treatment for local anesthetic toxicity" — Central Sadai (clinical) [Ep 13 · 10:31](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=631)
- "Exparel provides 72 hours of analgesia in donor nephrectomy patients, allowing PCA discontinuation one day earlier" — Central Sadai (clinical) [Ep 13 · 10:43](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=643)
- "Exparel is not FDA-approved for pediatric use" — Central Sadai (guideline) [Ep 13 · 10:52](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=652)
- "Cincinnati allows pectus patients with epidural to ambulate inside the room and outside with help; Foley catheter removed next day" — Central Sadai (clinical) [Ep 13 · 12:05](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=725)
- "Cincinnati has three separate pain services; surgical pain service manages all surgical patients including pectus" — Central Sadai (clinical) [Ep 13 · 13:52](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=832)
- "Surgical pain patients are seen minimum 3 times daily (morning, afternoon, evening rounds) with 24/7 availability" — Central Sadai (clinical) [Ep 13 · 14:12](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=852)
- "Meditation and mindfulness practices have evidence for minimizing pain, anxiety, and improving immune function after surgery" — Central Sadai (clinical) [Ep 13 · 15:46](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=946)
- "20-30% of pectus patients experience chronic persistent post-operative pain (CPSP), defined as pain score 3 or more at 2 months after surgery" — Central Sadai (epidemiological) [Ep 13 · 18:00](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1080)
- "Opioids have narrow therapeutic index; beyond a certain dose they do not relieve more pain but cause more side effects" — Central Sadai (clinical) [Ep 13 · 18:33](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1113)
- "Regional analgesia (epidural or On-Q) reduces persistent postoperative pain compared to systemic opioids alone" — Central Sadai (clinical) [Ep 13 · 19:24](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1164)
- "If a child is on opioids for 5 days in a row, the risk of dependence goes up significantly" — Central Sadai (clinical) [Ep 13 · 19:50](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1190)
- "Cincinnati places epidurals before surgery in awake patients with minimal sedation to minimize neurological injury risk" — Central Sadai (clinical) [Ep 13 · 20:22](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1222)
- "A 2023 meta-analysis of 6 studies found epidural provided better pain control than PCA in the first 2 days after pectus repair" — Central Sadai (clinical) [Ep 13 · 21:42](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1302)
- "Epidural success rate determines pain control effectiveness; studies with 22-35% epidural failure rates showed poor outcomes" — Central Sadai (clinical) [Ep 13 · 22:29](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1349)
- "Cincinnati epidural placement takes 10-15 minutes and results in fewer calls to anesthesia due to proactive rounding" — Central Sadai (clinical) [Ep 13 · 23:13](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1393)
- "With effective epidural, Cincinnati sees zero pain scores immediately after pectus surgery in first 2-3 days" — Central Sadai (clinical) [Ep 13 · 23:28](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1408)
- "Cincinnati uses local anesthetic-only epidural solution (no opioids) which does not cause urinary retention and is dermatomal" — Central Sadai (clinical) [Ep 13 · 23:46](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1426)
- "Most Cincinnati pectus patients are discharged on day 3 or 4 after surgery" — Central Sadai (clinical) [Ep 13 · 24:18](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1458)
- "Cincinnati's epidural success rate is more than 95%; less than 5% of patients need PCA on top of epidural (down from 14% in 2013)" — Central Sadai (clinical) [Ep 13 · 25:02](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1502)
- "Pregabalin or gabapentin given one hour before surgery significantly decreases postoperative pain and opioid need" — Central Sadai (clinical) [Ep 13 · 25:45](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1545)
- "Cincinnati uses maximum 5mg intraoperative methadone dose in teenagers (reduced from adult doses of 15-20mg) to avoid excessive sedation" — Central Sadai (clinical) [Ep 13 · 27:15](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1635)
- "Methadone can cause QT interval prolongation; Cincinnati performs baseline and postoperative EKG monitoring" — Central Sadai (clinical) [Ep 13 · 28:19](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1699)
- "Less than 5% of Cincinnati pectus patients need any IV opioid in first 2-3 days with epidural and multimodal regimen" — Central Sadai (clinical) [Ep 13 · 28:47](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1727)
- "Cincinnati stops epidural abruptly at 6am on postoperative day 3 without weaning" — Central Sadai (clinical) [Ep 13 · 31:27](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1887)
- "Opioids in epidural solution cause minimal benefit but significant problems (itching, urinary retention); clonidine provides equivalent analgesia without these side effects" — Central Sadai (clinical) [Ep 13 · 31:56](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1916)
- "Cincinnati uses high concentration ropivacaine 0.2% for epidural; lower concentrations (0.12-0.15%) provide inadequate pain relief" — Central Sadai (clinical) [Ep 13 · 32:22](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1942)
- "About 50% of patients develop opioid-induced constipation when oxycodone is started" — Central Sadai (epidemiological) [Ep 13 · 35:14](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2114)
- "Naloxegol relieves opioid-induced constipation without reversing analgesia because it does not cross the blood-brain barrier" — Central Sadai (clinical) [Ep 13 · 35:21](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2121)
- "In spine surgery patients receiving PCA (not epidural), about 15% experience respiratory depression (respiratory rate <8 or oxygen saturation <90%)" — Central Sadai (clinical) [Ep 13 · 36:52](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2212)
- "Tramadol is metabolized similarly to codeine; 10-12% of population are poor metabolizers with inadequate pain relief, 1-2% are ultra-rapid metabolizers at risk for respiratory depression and death" — Central Sadai (clinical) [Ep 13 · 37:48](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2268)
- "Ultra-rapid metabolizer prevalence is 1-2% in Cincinnati population but up to 29% in Ethiopian population" — Central Sadai (epidemiological) [Ep 13 · 49:38](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2978)
- "FDA has warned against codeine use following tonsillectomy; tramadol and hydrocodone warnings are under FDA review" — Central Sadai (guideline) [Ep 13 · 50:00](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3000)
- "Oxycodone is least affected by CYP2D6 metabolism among currently available oral opioids" — Central Sadai (clinical) [Ep 13 · 50:13](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3013)
- "Cincinnati avoids oxycodone in ultra-rapid metabolizers and uses hydromorphone (Dilaudid) instead" — Central Sadai (clinical) [Ep 13 · 50:24](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3024)
- "Sedation always precedes respiratory depression; Cincinnati nurses monitor sedation every shift using Ramsay scale" — Central Sadai (clinical) [Ep 13 · 51:29](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3089)
- "Cincinnati monitors end-tidal CO2 continuously for first 24 hours after pectus surgery" — Central Sadai (clinical) [Ep 13 · 51:44](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3104)
- "Cincinnati has not used naloxone for any pain patients in more than 3 years" — Central Sadai (clinical) [Ep 13 · 51:54](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3114)
- "CYP2D6 genetic testing costs less than $1 per gene; 50-gene panel costs $50" — Central Sadai (clinical) [Ep 13 · 52:19](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3139)
- "Genetic testing for fatty acid amide hydrolase gene associated with nausea/vomiting saves more than $100 per patient by reducing PACU stay" — Central Sadai (clinical) [Ep 13 · 52:42](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3162)
- "Pectus excavatum is the most common congenital chest deformity" — Joshua Ramjist (epidemiological) [Ep 27 · 0:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=0)
- "Pectus excavatum affects one in 400 births" — Joshua Ramjist (epidemiological) [Ep 27 · 0:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=0)
- "Pectus excavatum affects patients at a vulnerable time in their lives in the childhood and adolescent years" — Joshua Ramjist (clinical) [Ep 27 · 0:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=0)
- "The Nuss procedure has been revolutionary in correcting pectus excavatum deformity" — Joshua Ramjist (opinion) [Ep 27 · 0:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=0)
- "Despite an excellent operation, the post-operative period has been plagued by pain which has resulted in significant morbidity and increased length of stay" — Joshua Ramjist (clinical) [Ep 27 · 0:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=0)
- "The five-point ERAS protocol spans the entirety of the patient's perioperative experience" — Joshua Ramjist (clinical) [Ep 27 · 1:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=60)
- "The protocol includes perioperative education and counseling to establish reasonable expectations using educational materials and a boarding pass" — Joshua Ramjist (clinical) [Ep 27 · 1:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=60)
- "The transitional pain service facilitates both pharmacologic and non-pharmacologic interventions to manage patient pain" — Joshua Ramjist (clinical) [Ep 27 · 1:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=60)
- "Multimodal analgesia intraoperatively includes serratus anterior block and cryoablation at the time of procedure" — Joshua Ramjist (clinical) [Ep 27 · 1:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=60)
- "A perioperative bowel regimen was included in the protocol" — Joshua Ramjist (clinical) [Ep 27 · 1:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=60)
- "The boarding pass was a primary instrument to facilitate shared decision making and establish a therapeutic relationship between the team and patients" — Joshua Ramjist (clinical) [Ep 27 · 1:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=60)
- "This is a single institution study at the Hospital for Sick Children with retrospective data for the pre-ERAS cohort and prospective data after implementation" — Joshua Ramjist (clinical) [Ep 27 · 3:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=180)
- "53 patients were recruited from August 2015 to December 2021" — Joshua Ramjist (clinical) [Ep 27 · 3:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=180)
- "All patients were approximately 15 years of age at the time of repair" — Joshua Ramjist (clinical) [Ep 27 · 3:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=180)
- "Haller indices were typically above 4.5" — Joshua Ramjist (clinical) [Ep 27 · 3:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=180)
- "92% of patients expressed satisfaction with their overall experience" — Joshua Ramjist (clinical) [Ep 27 · 3:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=180)
- "There was a significant decrease in length of stay by 50%, from 4 days to just under 2 days" — Joshua Ramjist (clinical) [Ep 27 · 4:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=240)
- "The mean length of stay was 1.8 days" — Joshua Ramjist (clinical) [Ep 27 · 4:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=240)
- "The majority of patients were leaving on post-operative day one" — Joshua Ramjist (clinical) [Ep 27 · 4:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=240)
- "There was a significant decrease in opioid consumption in the post-operative period from 6.36 to 3.12 morphine milliequivalents" — Joshua Ramjist (clinical) [Ep 27 · 4:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=240)
- "Surgery remains a team sport" — Joshua Ramjist (opinion) [Ep 27 · 5:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=300)
- "Successful surgical outcomes are predicated on a multi-disciplinary team working in each phase of care to optimize the patient's experience" — Joshua Ramjist (opinion) [Ep 27 · 5:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=300)
- "A new index exists to measure the extent of sternal depression in pectus excavatum." — Sofía Tacchella (clinical) [Ep 30 · 0:00](https://library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=0)
- "The study was a retrospective study conducted at Clínica Mipetus, Buenos Aires, Argentina." — Sofía Tacchella (clinical) [Ep 30 · 1:00](https://library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=60)
- "Patients underwent minimally invasive repair of pectus excavatum between June 2020 and April 2022." — Sofía Tacchella (clinical) [Ep 30 · 1:15](https://library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=75)
- "The new index is called the Titanic Index." — Sofía Tacchella (clinical) [Ep 30 · 1:35](https://library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=95)
- "The Titanic Index evaluates the percentage of sternum located posterior to the anterior costal line on computed tomography." — Sofía Tacchella (clinical) [Ep 30 · 1:45](https://library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=105)
- "The index measures the craniocaudal extent of the depressed sternum." — Sofía Tacchella (clinical) [Ep 30 · 2:05](https://library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=125)
- "The study included 78 patients." — Sofía Tacchella (clinical) [Ep 30 · 2:15](https://library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=135)
- "The Haller index, correction index, and Titanic Index were measured in all patients." — Sofía Tacchella (clinical) [Ep 30 · 2:20](https://library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=140)
- "Patients were divided into two groups based on the number of implants placed." — Sofía Tacchella (clinical) [Ep 30 · 2:30](https://library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=150)
- "Group A received only two implants and comprised 47% of patients." — Sofía Tacchella (clinical) [Ep 30 · 2:40](https://library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=160)
- "Group B received three or more implants and comprised 53% of patients." — Sofía Tacchella (clinical) [Ep 30 · 2:50](https://library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=170)
- "A Titanic Index greater than 66% has a sensitivity of 93% for predicting the need for more than two implants." — Sofía Tacchella (clinical) [Ep 30 · 3:00](https://library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=180)
- "A Titanic Index greater than 66% has a specificity of 92% for predicting the need for more than two implants." — Sofía Tacchella (clinical) [Ep 30 · 3:15](https://library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=195)
- "The Titanic Index is a better predictor of the number of implants needed than the Haller index or the correction index." — Sofía Tacchella (clinical) [Ep 30 · 3:30](https://library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=210)
- "Minimally invasive repair of pectus excavatum is used to correct the most common thoracic anomaly in pediatric patients" — Britney Hegdy (clinical) [Ep 28 · 0:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=0)
- "Minimally invasive approach has been associated with decreased operative time, less blood loss and a quicker return to baseline compared to previous open approaches" — Britney Hegdy (clinical) [Ep 28 · 0:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=0)
- "MIRPE remains a painful procedure that historically required multiple adjuncts and a large amount of narcotics to achieve pain relief" — Britney Hegdy (clinical) [Ep 28 · 0:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=0)
- "A previous study at the institution found the use of cryo during minimally invasive repair lowered post-operative opioid use and hospital length of stay without increasing complications" — Britney Hegdy (clinical) [Ep 28 · 0:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=0)
- "Cryoablation is performed thoracoscopically using cryo nerve block probes under direct visualization" — Britney Hegdy (clinical) [Ep 28 · 1:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=60)
- "Probes are inserted via thoracoscopic port sites and activated at the site of intercostal nerves, usually bilaterally and within intercostal spaces three through seven" — Britney Hegdy (clinical) [Ep 28 · 1:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=60)
- "Cryo ablation subjects the intercostal nerves to extreme cold and is estimated to allow for pain control lasting weeks to months post ablation" — Britney Hegdy (clinical) [Ep 28 · 1:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=60)
- "Study included pediatric patients less than 18 from January 2011 to December 2021 who underwent minimally invasive repair" — Britney Hegdy (epidemiological) [Ep 28 · 3:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=180)
- "Cryo was introduced at the institution in November 2016 and every patient treated after this date received it" — Britney Hegdy (clinical) [Ep 28 · 3:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=180)
- "Of the 44 patients included, 29 (65.9%) received cryo during minimally invasive repair" — Britney Hegdy (epidemiological) [Ep 28 · 4:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=240)
- "A greater percentage in both treatment groups were male" — Britney Hegdy (epidemiological) [Ep 28 · 4:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=240)
- "Both treatment groups were similar regarding age, height, weight, insurance status, race, symptoms at presentation and Haller index" — Britney Hegdy (epidemiological) [Ep 28 · 4:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=240)
- "Bayesian models were used to analyze the impact of cryo on various outcomes utilizing a neutral prior assuming no treatment effect" — Britney Hegdy (clinical) [Ep 28 · 5:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=300)
- "Cryo use was associated with an 89% probability of total hospital cost reduction compared to no cryo use with a difference in total cost of $880" — Britney Hegdy (clinical) [Ep 28 · 5:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=300)
- "The decrease in total cost is likely attributable to the impact of cryo use on hospital days" — Britney Hegdy (opinion) [Ep 28 · 5:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=300)
- "Cryo use was associated with a 100% probability of reduction in index hospital days compared to no cryo use" — Britney Hegdy (clinical) [Ep 28 · 5:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=300)
- "When comparing total hospital days including readmissions during 90 days, there was a 99% probability of total hospital days reduction with the use of cryo" — Britney Hegdy (clinical) [Ep 28 · 5:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=300)
- "The incidence of post-operative complications did not differ between treatment groups" — Britney Hegdy (clinical) [Ep 28 · 6:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=360)
- "Cryo use was associated with a 70% probability of reduction in post-operative complications compared to no cryo use" — Britney Hegdy (clinical) [Ep 28 · 6:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=360)
- "Total hospital cost data was adjusted for inflation by the consumer price index for medical services" — Britney Hegdy (clinical) [Ep 28 · 3:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=180)
- "Pectus excavatum repair is the most painful procedure performed on children, more so than spine surgery" — Sean St. Peter (opinion) [Ep 23 · 2:47](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=167)
- "In randomized trial of 110 patients, epidural catheters did not show pain reduction advantage over PCA, with pain persisting on days 2-3 due to transition issues" — Sean St. Peter (clinical) [Ep 23 · 3:05](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=185)
- "Cryoanalgesia technique: freeze intercostal nerves 4 through 7, two minutes per rib, one interspace separation between camera and probe" — Sean St. Peter (clinical) [Ep 23 · 7:00](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=420)
- "Should not perform cryoanalgesia below rib 8 due to risk of abdominal wall paralysis" — Sean St. Peter (clinical) [Ep 23 · 7:30](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=450)
- "In prospective observational cryoanalgesia cohort, six of nine patients went home on post-op day one" — Sean St. Peter (clinical) [Ep 23 · 7:45](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=465)
- "Median length of stay with cryoanalgesia is one day, with tight range except for occasional failures that revert to four days" — Sean St. Peter (clinical) [Ep 23 · 8:05](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=485)
- "Median morphine equivalents with cryoanalgesia versus other modalities are not on the same planet—dramatically lower" — Sean St. Peter (clinical) [Ep 23 · 8:30](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=510)
- "Medical devices and implants are not required to undergo clinical trials before market introduction, unlike drugs" — Victor Garcia (guideline) [Ep 23 · 10:00](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=600)
- "Cryotherapy device received FDA approval via 510k predicate pathway based on similarity to 1976 device, not clinical trial data" — Victor Garcia (guideline) [Ep 23 · 14:10](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=850)
- "With erector spinae catheters, hospital stay is two days, opioid requirements reduced both in-hospital and post-discharge" — Victor Garcia (clinical) [Ep 23 · 27:43](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1663)
- "Erector spinae catheters stay in for five days total, with family removing them at home on day three after discharge" — Victor Garcia (clinical) [Ep 23 · 28:10](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1690)
- "ERAS protocol without cryoanalgesia or catheters achieves length of stay under two days at Nebraska, patients off opioids by one week" — Justin Wagner (clinical) [Ep 23 · 24:10](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1450)
- "Gabapentin dosing for pectus: 200-300mg three times daily for up to one week post-op, ideally started several days pre-op" — Justin Wagner (clinical) [Ep 23 · 22:30](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1350)
- "In Texas Children's study, 50% of patients still taking opioids two weeks post-Nuss procedure" — Justin Wagner (epidemiological) [Ep 23 · 23:20](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1400)
- "Bar flippage rate with cryoanalgesia is eight times higher than without cryo in one study" — Justin Wagner (clinical) [Ep 23 · 24:40](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1480)
- "Allodynia and neuropathy occur six times more frequently in cryoanalgesia group versus non-cryo" — Justin Wagner (clinical) [Ep 23 · 25:00](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1500)
- "Urinary retention is lower with cryoanalgesia (8%) versus non-cryo (34%)" — Justin Wagner (clinical) [Ep 23 · 24:20](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1460)
- "When bars flip, it is always a technical issue—bar sitting in wrong interspace, not wrapped tight enough, or not secured properly" — Sean St. Peter (opinion) [Ep 23 · 31:37](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1897)
- "Activity restrictions lifted at two weeks post-op for cryoanalgesia patients; can return to bull riding, boxing, football, hockey" — Sean St. Peter (clinical) [Ep 23 · 32:10](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1930)
- "Bar rotation rate of 0.7% in series of 554 patients using mid-axillary bar measurement" — Sean St. Peter (clinical) [Ep 23 · 39:16](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2356)
- "Epidural catheters could not be placed or were removed after one day in approximately 25% of patients in randomized trial" — Whit (clinical) [Ep 23 · 26:24](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1584)
- "Sub-xiphoid incision technique allows palpation-guided bar passage and was associated with 0% pericarditis rate" — Sean St. Peter (clinical) [Ep 23 · 43:44](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2624)
- "Sternal elevator used in approximately 10% of cases—primarily older males over 16 with Haller index over 3.5 and stiff chest walls" — Steven Rothenberg (clinical) [Ep 23 · 47:23](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2843)
- "Sternal elevator allows entry at mid-clavicular line, reduces intercostal tears, and improves bar stability in deep stiff pectus cases" — Steven Rothenberg (clinical) [Ep 23 · 46:20](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2780)
- "Computational models show shorter flat bars focus stress on sternum while larger curved bars create parasitic horizontal and torque forces at bar ends" — Justin Wagner (clinical) [Ep 23 · 38:00](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2280)
- "Passing bar left-to-right angles away from the ventricle, reducing cardiac injury risk compared to right-to-left" (opinion) [Ep 23 · 28:45](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1725)
- "Most patients retain normal anterior chest sensation even 2-3 weeks post-cryoanalgesia, suggesting nerve stunning rather than complete death" — Sean St. Peter (clinical) [Ep 23 · 18:40](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1120)
- "Adult thoracotomy cryotherapy experience spans 20 years without high enough complication incidence to warrant concern" — Sean St. Peter (epidemiological) [Ep 23 · 19:10](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1150)
- "With cryoanalgesia, 70% of patients discharged home on post-op day one without narcotics" — Steven Rothenberg (clinical) [Ep 23 · 34:19](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2059)
- "Patients at two weeks post-cryoanalgesia do not notice chest wall numbness as a significant issue" — Steven Rothenberg (clinical) [Ep 23 · 33:40](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2020)
- "The Titanic Index measures the percentage of sternum that lies under the anterior costal line" — Luzia Toselli (clinical) [Ep 31 · 2:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=120)
- "The study included 78 patients between 2020 and 2022, with 47% receiving two bars and 53% receiving more than two bars" — Luzia Toselli (clinical) [Ep 31 · 2:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=132)
- "A Titanic Index cutpoint of 66.5% predicted need for more than two implants with 93% sensitivity and 92% specificity" — Luzia Toselli (clinical) [Ep 31 · 3:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=180)
- "Severe outcomes in button battery ingestion were defined as deep mucosal erosion, perforation, mediastinitis, vascular or airway injury or fistula, and development of esophageal stricture" — Ellen Encisco (clinical) [Ep 31 · 5:36](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=336)
- "The Boston study included 143 patients under 21 years old from 2008 to 2021, with 24 having severe outcomes" — Ellen Encisco (epidemiological) [Ep 31 · 6:05](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=365)
- "Three predictive factors for severe button battery outcomes were: presence in esophagus at presentation, two centimeter or larger battery size, and presence of any symptoms" — Ellen Encisco (clinical) [Ep 31 · 6:20](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=380)
- "Time to removal was not a significant predictor of severe outcomes in the button battery series" — Farokh Demeri (clinical) [Ep 31 · 7:24](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=444)
- "The choledochal cyst study analyzed 577 patients aged 0-21 years from 2016 to 2018 in a national database" — Chad Thorson (epidemiological) [Ep 31 · 8:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=534)
- "28% of choledochal cyst procedures were done laparoscopically and the rest were done open" — Chad Thorson (epidemiological) [Ep 31 · 8:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=534)
- "Most open procedures for choledochal cysts were hepaticojejunostomy and most laparoscopic procedures were hepaticoduodenostomy" — Chad Thorson (clinical) [Ep 31 · 8:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=534)
- "Patients receiving open operations had inferior outcomes including longer length of stay, higher cost, more TPN use, and more central line requirements" — Chad Thorson (clinical) [Ep 31 · 9:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=567)
- "There was no significant difference in post-operative cholangitis or mortality between laparoscopic and open choledochal cyst resection" — Mark Wulkan (clinical) [Ep 31 · 10:32](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=632)
- "Laparoscopic biliary anastomosis for choledochal cysts has a learning curve and is not recommended for early career surgeons without assistance" (opinion) [Ep 31 · 10:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=654)
- "A 16-year-old male with shortness of breath on exertion, no comorbidities, and pectus index of 5.5 was planned for chest wall reconstruction" — Todd Ponsky (clinical) [Ep 56 · 0:31](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=31)
- "A randomized trial of 110 patients comparing epidural and PCA showed epidurals did not provide adequate pain control" — Todd Ponsky (clinical) [Ep 56 · 1:02](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=62)
- "After implementing cryoanalgesia, a patient went home on post-operative day one, ending equipoise in the trial" — Cecilia Gigena (clinical) [Ep 56 · 1:21](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=81)
- "Cryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain" — Todd Ponsky (clinical) [Ep 56 · 1:56](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=116)
- "Cryoanalgesia technique involves freezing ribs four through seven for two minutes per rib; ribs eight and below should not be treated due to risk of abdominal wall paralysis" — Todd Ponsky (clinical) [Ep 56 · 2:09](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=129)
- "Cryoanalgesia reduced hospital length of stay from four days to one day" — Cecilia Gigena (clinical) [Ep 56 · 2:33](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=153)
- "Cryoanalgesia dramatically reduced median morphine equivalents compared to previous pain management approaches" — Todd Ponsky (clinical) [Ep 56 · 2:43](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=163)
- "There are no long-term studies on cryoanalgesia outcomes, raising concerns about potential chronic neuropathic pain" — Cecilia Gigena (opinion) [Ep 56 · 2:52](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=172)
- "Medical devices and techniques are not required to undergo clinical trials before market introduction, unlike medications" — Todd Ponsky (guideline) [Ep 56 · 3:14](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=194)
- "Erector spinae catheters are placed by the pain team with ultrasound guidance, stay in for five days, and allow hospital discharge at two days with family removal of catheters on day three" — Cecilia Gigena (clinical) [Ep 56 · 3:50](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=230)
- "Erector spinae catheters reduced opioid requirements both in-hospital and post-discharge, achieving two-day hospital stays" — Todd Ponsky (clinical) [Ep 56 · 4:30](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=270)
- "Cryoanalgesia changed not just discharge timing but how patients feel at discharge" — Cecilia Gigena (opinion) [Ep 56 · 4:52](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=292)
- "Multimodal pain control includes Tylenol, NSAIDs, precedex for gentle wake-up, dexamethasone for nausea, ketamine to avoid opioids, child life specialists, mindfulness resources, and physical therapy" — Todd Ponsky (clinical) [Ep 56 · 5:34](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=334)
- "Best multimodal treatments are preoperative counseling, gabapentin pre and postoperatively, methadone, clonidine, bowel regimen medications, and antiemetics" — Cecilia Gigena (clinical) [Ep 56 · 6:15](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=375)
- "A multimodal pain regimen achieved hospital length of stay under two days with patients off opioids by one week" — Cecilia Gigena (clinical) [Ep 56 · 6:15](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=375)
- "Bar flippage typically occurs early due to bars sitting in incorrect intercostal space, poor positioning, inadequate wrapping, or insufficient securing" — Todd Ponsky (clinical) [Ep 56 · 6:26](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=386)
- "Bar flippage is completely a surgical technique issue, not related to the securing method" — Todd Ponsky (opinion) [Ep 56 · 6:26](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=386)
- "Computational modeling shows shorter flat bars create more pressure on the sternum compared to traditional U-shaped bars, making them more stable" — Cecilia Gigena (clinical) [Ep 56 · 7:35](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=455)
- "Sternal elevator is used in approximately 10% of cases, primarily in younger patients where thoracoscopy provides adequate visualization" — Todd Ponsky (clinical) [Ep 56 · 8:01](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=481)
- "Sternal elevation in deep, stiff pectus cases allows less tissue damage and better repair" — Todd Ponsky (clinical) [Ep 56 · 8:01](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=481)
- "Sternal elevator enables consistent entry and exit at the same intercostal space" — Todd Ponsky (clinical) [Ep 56 · 8:01](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=481)
- "Thoracoscopy, sternal elevator, vacuum bell, and sub-xiphoid incision are all techniques aimed at preventing cardiac injury" — Cecilia Gigena (clinical) [Ep 56 · 8:58](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=538)
- "Passing the bar from left to right avoids pointing the introducer directly at the ventricle" — Todd Ponsky (clinical) [Ep 56 · 9:20](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=560)
- "Bar passage direction is surgeon preference and does not make significant difference if sub-sternal space is well dissected and clear" — Todd Ponsky (opinion) [Ep 56 · 9:20](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=560)
- "A randomized trial of 110 patients comparing epidural and PCA for pectus excavatum pain control showed epidurals did not provide superior pain relief" (clinical) [Ep 57 · 1:02](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=62)
- "After implementing cryoanalgesia, a patient went home on postoperative day one, leading to loss of equipoise in the trial comparing cryotherapy to epidural/PCA" — Cecilia Gigena (clinical) [Ep 57 · 1:21](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=81)
- "Cryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain" (clinical) [Ep 57 · 1:56](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=116)
- "Cryoanalgesia technique involves freezing underneath ribs 4 through 7 for two minutes per rib" — Cecilia Gigena (clinical) [Ep 57 · 2:07](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=127)
- "Cryoanalgesia should not be applied to rib 8 or below because it can cause abdominal wall paralysis" — Cecilia Gigena (clinical) [Ep 57 · 2:07](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=127)
- "After implementing cryoanalgesia, length of stay decreased from four days (previous baseline) to one day" (clinical) [Ep 57 · 2:33](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=153)
- "Cryoanalgesia dramatically reduced median morphine equivalents compared to previous pain control methods" — Cecilia Gigena (clinical) [Ep 57 · 2:43](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=163)
- "There are no long-term studies on cryoanalgesia outcomes for pectus excavatum repair" (clinical) [Ep 57 · 2:52](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=172)
- "Medical devices and implants are not required to undergo clinical trials before introduction to market, unlike drugs" — Cecilia Gigena (guideline) [Ep 57 · 3:14](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=194)
- "FDA requires clinical trials with long-term results before approving medications for use" — Cecilia Gigena (guideline) [Ep 57 · 3:35](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=215)
- "A comparison study of approximately 100 patients examined epidurals versus erector spinae catheters for pectus excavatum pain control" — Cecilia Gigena (clinical) [Ep 57 · 3:50](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=230)
- "Erector spinae catheters are placed by the pain team with ultrasound guidance and are juxtaposed to but not in the vertebral space" — Cecilia Gigena (clinical) [Ep 57 · 4:08](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=248)
- "Erector spinae catheters stay in place for five days on an automated pump, with families removing them on day three while patients are at home" — Cecilia Gigena (clinical) [Ep 57 · 4:08](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=248)
- "With erector spinae catheters, hospital length of stay is two days" (clinical) [Ep 57 · 4:30](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=270)
- "Erector spinae catheters reduced opioid requirements both in the hospital and outside the hospital" (clinical) [Ep 57 · 4:30](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=270)
- "Cryoanalgesia changes not just when patients go home but how they feel when they go home" (opinion) [Ep 57 · 4:30](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=270)
- "Multimodal pain control for pectus excavatum includes Tylenol, NSAIDs, precedex for gentle wake up, dexamethasone for post-anesthetic nausea, ketamine to avoid opioids, child life specialists, mindfulness resources, and physical therapists" — Cecilia Gigena (clinical) [Ep 57 · 5:34](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=334)
- "Optimal multimodal therapy includes preoperative counseling, gabapentin both pre and postoperatively, methadone, clonidine, bowel regimen medications, and antiemetics" (clinical) [Ep 57 · 6:02](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=362)
- "At one center using multimodal pain control, length of stay is under two days and patients are off opioids by one week" (clinical) [Ep 57 · 6:02](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=362)
- "When bars flip, they typically flip early due to sitting in a funky intercostal space, sitting in a bad spot, insufficient bar wrapping, or inadequate securing" — Cecilia Gigena (clinical) [Ep 57 · 6:26](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=386)
- "Bar flipping is completely a surgical technique issue, not related to the securing method" — Cecilia Gigena (opinion) [Ep 57 · 6:26](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=386)
- "Computational modeling shows that shorter flat bars create more pressure on the sternum compared to traditionally U-shaped bars, making them more stable" (clinical) [Ep 57 · 7:35](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=455)
- "One center uses sternal elevator in about 10% of cases, primarily in younger patients where thoracoscopy provides adequate visualization" — Cecilia Gigena (clinical) [Ep 57 · 8:01](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=481)
- "Sternal elevation in really deep stiff pectus cases allows less tissue damage and better repair" — Cecilia Gigena (clinical) [Ep 57 · 8:01](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=481)
- "One center uses sternal elevator in every case to eliminate guesswork and enable consistent access to the same intercostal space" — Cecilia Gigena (clinical) [Ep 57 · 8:01](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=481)
- "Thoracoscopy, sternal elevator, vacuum bell in the operating room, and sub-xiphoid incision are all techniques aimed at preventing cardiac injury during pectus repair" (clinical) [Ep 57 · 8:58](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=538)
- "Passing the bar from right chest to left chest means the introducer is pointing directly at the ventricle" — Cecilia Gigena (clinical) [Ep 57 · 9:20](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=560)
- "Bar passage direction (left-to-right versus right-to-left) probably does not make a significant difference as long as the sub-sternal space is well dissected and everything is clear" — Cecilia Gigena (opinion) [Ep 57 · 9:20](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13669?t=560)
- "A randomized trial of 110 patients comparing epidural and PCA for pectus excavatum pain control showed that epidurals did not provide superior pain relief" — Cecilia Gigena (clinical) [Ep 58 · 1:02](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=62)
- "After implementing cryoanalgesia, a patient went home on post-operative day one, which was a dramatic improvement over previous pain control methods" (clinical) [Ep 58 · 1:21](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=81)
- "Cryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain" — Cecilia Gigena (clinical) [Ep 58 · 1:56](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=116)
- "The cryoanalgesia technique involves freezing underneath ribs four through seven for two minutes per rib" — Cecilia Gigena (clinical) [Ep 58 · 2:09](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=129)
- "Cryoanalgesia should not be performed on rib eight or below because it can cause abdominal wall paralysis" — Cecilia Gigena (clinical) [Ep 58 · 2:09](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=129)
- "With cryoanalgesia, hospital length of stay decreased from four days to one day" (clinical) [Ep 58 · 2:33](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=153)
- "Cryoanalgesia dramatically reduced median morphine equivalents compared to previous pain control methods" — Cecilia Gigena (clinical) [Ep 58 · 2:43](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=163)
- "There are no long-term studies on cryoanalgesia outcomes" (clinical) [Ep 58 · 2:52](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=172)
- "Medical devices and techniques are not required to undergo clinical trials before introduction to market, unlike medications" — Cecilia Gigena (guideline) [Ep 58 · 3:14](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=194)
- "Erector spinae catheters are placed by the pain team with ultrasound guidance and are juxtaposed to but not in the vertebral space" (clinical) [Ep 58 · 4:08](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=248)
- "Erector spinae catheters stay in for five days, with hospital stay of two days, and catheters are pulled out by the family on the third day while at home" (clinical) [Ep 58 · 4:08](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=248)
- "Erector spinae catheters reduced opioid requirements both in the hospital and outside of the hospital" — Cecilia Gigena (clinical) [Ep 58 · 4:30](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=270)
- "With erector spinae catheters, hospital stay is two days, which is much less than the four or five days seen with epidurals" — Cecilia Gigena (clinical) [Ep 58 · 4:30](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=270)
- "Cryoanalgesia changed not just when patients go home but how they feel when they go home" (opinion) [Ep 58 · 4:50](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=290)
- "For multimodal pain therapy, the best treatments are preoperative counseling, gabapentin both pre and postoperatively, methadone, clonidine, bowel regimen medications and antiemetics" — Cecilia Gigena (clinical) [Ep 58 · 5:40](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=340)
- "With multimodal pain control at one institution, length of stay is under two days and patients are off opioids by one week" — Cecilia Gigena (clinical) [Ep 58 · 6:20](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=380)
- "If bars are going to flip, they flip early because they were sitting in a bad spot, the bar was not wrapped tight enough, or it was not secured well" (clinical) [Ep 58 · 6:40](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=400)
- "Bar flippage is completely a surgical issue related to bar positioning and securing technique" (opinion) [Ep 58 · 6:40](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=400)
- "Computational modeling showed that shorter flat bars have more pressure on the sternum compared to traditionally U-shaped bars, making them more stable" — Cecilia Gigena (clinical) [Ep 58 · 7:00](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=420)
- "Sternal elevator is used in about 10% of cases at one institution" — Cecilia Gigena (clinical) [Ep 58 · 7:40](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=460)
- "In younger patients with average anatomy, thoracoscopy provides adequate visualization without needing a sternal elevator" — Cecilia Gigena (clinical) [Ep 58 · 8:00](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=480)
- "In really deep stiff pectus cases, sternal elevation allows less tissue damage and a better repair" — Cecilia Gigena (clinical) [Ep 58 · 8:20](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=500)
- "One surgeon uses the sternal elevator in every case to eliminate guesswork and enable passage in and out at the same intercostal space" — Cecilia Gigena (clinical) [Ep 58 · 8:40](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=520)
- "Thoracoscopy, sternal elevator, vacuum bell in the operating room, or subxiphoid incision all serve the purpose of avoiding cardiac injury" — Cecilia Gigena (clinical) [Ep 58 · 9:00](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=540)
- "Passing the bar from left chest to right chest is preferred by some surgeons because going right to left means the introducer points directly at the ventricle" (opinion) [Ep 58 · 9:30](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=570)
- "Bar passage direction probably does not make a significant difference as long as the substernal space is well dissected and everything is clear" (opinion) [Ep 58 · 10:00](https://library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13670?t=600)
- "Cross-training occurs at Cincinnati Children's with interventional radiologists teaching pediatric surgery fellows ultrasound guidance for vascular access" (clinical) [Ep 55 · 2:00](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=120)
- "You don't have to have a hybrid OR to do surgical-IR collaboration; it can occur in regular OR by bringing in an ultrasound machine" (clinical) [Ep 55 · 2:20](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=140)
- "Cone beam CT is performed on a C-arm fluoroscopy unit that rotates around the patient collecting multiple images which are stacked to create a CT" (clinical) [Ep 55 · 3:00](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=180)
- "ChatGPT can screen thousands of articles in systematic review by analyzing Excel sheets and providing explanations for inclusion/exclusion decisions" (clinical) [Ep 55 · 4:40](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=280)
- "Jenny AI provides suggestions for research writing, cites supporting papers, and formats citations according to preferred style" (clinical) [Ep 55 · 5:30](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=330)
- "Cryoanalgesia temporarily freezes nerves to alleviate pain during chest wall surgery" (clinical) [Ep 55 · 7:10](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=430)
- "Double lumen endotracheal tube deflates the lung on the side of cryoablation and surgeon uses thoracoscope to guide cryoprobe through axillary incisions" (clinical) [Ep 55 · 7:30](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=450)
- "Cryoanalgesia targets nerves from T3 to T8 with two-minute freeze cycles" (clinical) [Ep 55 · 7:55](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=475)
- "Subpleural injection with quarter percent marcaine with epinephrine works immediately as opposed to eight to ten hour delay with cryo nerve block" (clinical) [Ep 55 · 8:10](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=490)
- "Double lumen endotracheal tube helps reduce risk of pneumothorax during cryoanalgesia" (clinical) [Ep 55 · 8:35](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=515)
- "Sphere Protocol from Michigan used prenatal criteria to guide decisions on offering ECMO versus comfort care for severe unilateral CDH, showing survival was equivalent between groups" (clinical) [Ep 55 · 10:20](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=620)
- "If you had good prenatal counseling with parents, you should pursue ECMO for every unilateral isolated CDH" (opinion) [Ep 55 · 10:55](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=655)
- "With bivalirudin anticoagulation, you can operate after eight hours of putting patient on ECMO as long as levels are stable" (clinical) [Ep 55 · 11:30](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=690)
- "Early repair while on ECMO is safe with optimal window between eight to 24 hours" (clinical) [Ep 55 · 11:50](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=710)
- "CO2 laser emits infrared light in spectrum of 920 to 1,400 nanometers which is well absorbed by water" (clinical) [Ep 55 · 12:10](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=730)
- "In 56 circumcision cases using CO2 laser with sleeve technique and cyanoacrylate adhesive, complication rate was only three percent" (clinical) [Ep 55 · 12:35](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=755)
- "Autofluorescence has shown to reduce rates of hyperparathyroidism and hypocalcemia following thyroidectomy in randomized control trial from France" (clinical) [Ep 55 · 13:30](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=810)
- "Parathyroids naturally autofluorescence at specific wavelength without injection" (clinical) [Ep 55 · 13:55](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=835)
- "Fluobeam system showed hypocalcemia rates about half with use versus not using it" (clinical) [Ep 55 · 14:10](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=850)
- "Surgery-first pathway reduces resource utilization including MRCP in pediatric biliary stone cases" (clinical) [Ep 55 · 14:40](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=880)
- "ERCP causes pancreatitis 10% of the time regardless of operator skill" (clinical) [Ep 55 · 15:00](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=900)
- "With surgery-first mindset, stone clearance rate reflected by negative intraoperative cholangiogram was 86%" (clinical) [Ep 55 · 15:15](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=915)
- "MMP7 was identified about 10 years ago as diagnostic biomarker for biliary atresia" (clinical) [Ep 55 · 15:45](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=945)
- "Data from Midwest study shows every 10-day delay in biliary atresia treatment worsens outcomes by 20%" (epidemiological) [Ep 55 · 16:05](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=965)
- "MMP7 is now validated biomarker for biliary atresia with good sensitivity, though cutoffs vary as assay is still evolving" (clinical) [Ep 55 · 16:25](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=985)
- "Cincinnati Children's commitment is to perform Kasai procedure within seven days of biliary atresia diagnosis" (clinical) [Ep 55 · 16:45](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=1005)
- "REBOA is procedure where catheter is inserted through femoral artery into aorta and balloon is inflated to stop blood flow, buying time for surgical intervention" (clinical) [Ep 55 · 17:10](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=1030)
- "REBOA seems to take longer than opening abdomen or chest if just needing to cross-clamp aorta" (opinion) [Ep 55 · 17:35](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=1055)
- "Most surgeons favor laparotomy over REBOA for quickly treating shock in controlled environment" (opinion) [Ep 55 · 17:45](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=1065)
- "Patients presenting with wounds as initial presentation for pilonidal tend to not always get to finish line fully healed with minimally invasive approach" (clinical) [Ep 55 · 18:05](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=1085)
- "Joan Armstrong's U.S. Army clinic implemented weekly shaving protocol in captive patient population and observed dramatic improvement, significantly reducing need for surgical intervention in pilonidal disease" (clinical) [Ep 55 · 18:20](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=1100)
- "If not pushing hair removal and meticulous hygiene, will probably end up operating on some pilonidal patients that might not need operation" (opinion) [Ep 55 · 18:45](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13593?t=1125)

## Changelog
- Aug 31: 64 doctors auto-found from episode dossiers
- Aug 30: 53 doctors auto-found from episode dossiers
- Aug 30: 49 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 58 doctors auto-found from episode dossiers
- Aug 29: 62 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 68 items, 53 dossiers, summaries for 3 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 58 items, 53 dossiers, summaries for 1 audience(s)
- Aug 29: Collection generated from campaign corpus: 58 items, 53 dossiers, summaries for 3 audience(s)

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Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://library.globalcastmd.com/ai