Shortness of Breath On Exertion
Everything in the library about shortness of breath on exertion — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Surgical Management
5 items
Update Course Rewind: Pectus Excavatum 2021
Listen →
Did you miss our 9th Annual Update Course last year?
Don't worry, we are summarizing our favorite sessions in this podcast!
In this Episode Drs. Steven Lee, Shawn St. Peter, Victor García, Steven Rothenberg, Whit Holcomb, & Justin Wagne
podcast11:56 · Aug 2022
Update Course Rewind: Pectus Excavatum 2021
Watch →
Did you miss our 9th Annual Update Course last year?
Don't worry, we are summarizing our favorite sessions in this podcast!
In this Episode Drs. Steven Lee, Shawn St. Peter, Victor García, Steven Rothenberg, Whit Holcomb, & Justin W
video11:56 · Sep 2022
Update Course Rewind: Pectus Excavatum 2021
Listen →
Did you miss our 9th Annual Update Course last year? Don
podcast11:55 · Jul 2026
Update Course Rewind: Pectus Excavatum 2021
Listen →
Did you miss our 9th Annual Update Course last year? Don
podcast11:55 · Jul 2026
Update Course Rewind: Pectus Excavatum 2021
Listen →
Did you miss our 9th Annual Update Course last year? Don't worry, we are summarizing our favorite sessions from years past. In this episode, Drs. Steven Lee, Shawn St. Peter, Victor García, Steven Rothenberg, Whit Holcomb, & Justin Wagner w
podcast11:55 · Jul 2026
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Update Course Rewind: Pectus Excavatum 2021
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
clinicalTodd Ponsky0:31 ↗
A randomized trial of 110 patients comparing epidural and PCA showed epidurals did not provide adequate pain control
clinicalTodd Ponsky1:02 ↗
After implementing cryoanalgesia, a patient went home on post-operative day one, ending equipoise in the trial
clinicalCecilia Gigena1:21 ↗
Cryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain
clinicalTodd Ponsky1:56 ↗
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
clinicalTodd Ponsky2:09 ↗
Cryoanalgesia reduced hospital length of stay from four days to one day
clinicalCecilia Gigena2:33 ↗
Cryoanalgesia dramatically reduced median morphine equivalents compared to previous pain management approaches
clinicalTodd Ponsky2:43 ↗
There are no long-term studies on cryoanalgesia outcomes, raising concerns about potential chronic neuropathic pain
opinionCecilia Gigena2:52 ↗
Medical devices and techniques are not required to undergo clinical trials before market introduction, unlike medications
guidelineTodd Ponsky3:14 ↗
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
clinicalCecilia Gigena3:50 ↗
Erector spinae catheters reduced opioid requirements both in-hospital and post-discharge, achieving two-day hospital stays
clinicalTodd Ponsky4:30 ↗
Cryoanalgesia changed not just discharge timing but how patients feel at discharge
opinionCecilia Gigena4:52 ↗
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
clinicalTodd Ponsky5:34 ↗
Best multimodal treatments are preoperative counseling, gabapentin pre and postoperatively, methadone, clonidine, bowel regimen medications, and antiemetics
clinicalCecilia Gigena6:15 ↗
A multimodal pain regimen achieved hospital length of stay under two days with patients off opioids by one week
clinicalCecilia Gigena6:15 ↗
Bar flippage typically occurs early due to bars sitting in incorrect intercostal space, poor positioning, inadequate wrapping, or insufficient securing
clinicalTodd Ponsky6:26 ↗
Bar flippage is completely a surgical technique issue, not related to the securing method
opinionTodd Ponsky6:26 ↗
Computational modeling shows shorter flat bars create more pressure on the sternum compared to traditional U-shaped bars, making them more stable
clinicalCecilia Gigena7:35 ↗
Sternal elevator is used in approximately 10% of cases, primarily in younger patients where thoracoscopy provides adequate visualization
clinicalTodd Ponsky8:01 ↗
Sternal elevation in deep, stiff pectus cases allows less tissue damage and better repair
clinicalTodd Ponsky8:01 ↗
Sternal elevator enables consistent entry and exit at the same intercostal space
clinicalTodd Ponsky8:01 ↗
Thoracoscopy, sternal elevator, vacuum bell, and sub-xiphoid incision are all techniques aimed at preventing cardiac injury
clinicalCecilia Gigena8:58 ↗
Passing the bar from left to right avoids pointing the introducer directly at the ventricle
clinicalTodd Ponsky9:20 ↗
Bar passage direction is surgeon preference and does not make significant difference if sub-sternal space is well dissected and clear
opinionTodd Ponsky9:20 ↗
A randomized trial of 110 patients comparing epidural and PCA for pectus excavatum pain control showed epidurals did not provide superior pain relief
clinical1:02 ↗
After implementing cryoanalgesia, a patient went home on postoperative day one, leading to loss of equipoise in the trial comparing cryotherapy to epidural/PCA
clinicalCecilia Gigena1:21 ↗
Cryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain
clinical1:56 ↗
Cryoanalgesia technique involves freezing underneath ribs 4 through 7 for two minutes per rib
clinicalCecilia Gigena2:07 ↗
Cryoanalgesia should not be applied to rib 8 or below because it can cause abdominal wall paralysis
clinicalCecilia Gigena2:07 ↗
After implementing cryoanalgesia, length of stay decreased from four days (previous baseline) to one day
clinical2:33 ↗
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