Centel Sadai

302 timestamped statements across 2 collections — auto-found in recorded discussions, each timestamp jumps to the exact moment.

Featured diaries

▶ Ep 7 · 28:47
In our experience, the number of patients needing any IV opioid in the 1st 2 or 3 days when they have epidural is less than 5% now
quote · Pectus Carinatum
▶ Ep 11 · 28:47
In our experience, the number of patients needing any IV opioid in the 1st 2 or 3 days when they have epidural is less than 5% now
quote · Pectus Excavatum
▶ Ep 11 · 28:47
In our experience, the number of patients needing any IV opioid in the 1st 2 or 3 days when they have epidural is less than 5% now
quote · Pectus Excavatum
▶ Ep 7 · 1:28
more than 95% of our patients do not get a PCA along with epidural, which says a lot about how we manage our epidural
quote · Pectus Carinatum

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Pectus Carinatum 58 entries

Pain Management: Pectus Innovations

▶ Ep 7 · 0:29
quote nothing is as good as epidural analogies here for Pus patients. Onup pumps come second to epidural in our experience ↗
▶ Ep 7 · 0:29
opinion Nothing is as good as epidural analgesia for pectus patients; On-Q pumps come second to epidural. ↗
▶ Ep 7 · 0:45
host_summary Seattle Children's Hospital has gone from epidural to On-Q pump recently and is having some issues. ↗
▶ Ep 7 · 1:28
quote more than 95% of our patients do not get a PCA along with epidural, which says a lot about how we manage our epidural ↗
▶ Ep 7 · 1:28
clinical More than 95% of Cincinnati's pectus patients do not get a PCA along with epidural. ↗
▶ Ep 7 · 2:24
clinical Older patients and young adults have more pain after pectus repair because of chest wall rigidity. ↗
▶ Ep 7 · 2:35
clinical Patients with Ehlers-Danlos syndrome have extensive pain and often have pain even before surgery. ↗
▶ Ep 7 · 3:29
host_summary Recent literature shows that if a child and their parent have pain catastrophization (anticipating negative outcomes), they are more likely to have more pain after surgery. ↗
▶ Ep 7 · 5:30
clinical Most neurological risk with epidural in children is from hypoperfusion of spinal cord, not from traumatic placement. ↗
▶ Ep 7 · 10:31
clinical Exparel (liposomal bupivacaine) is safer than plain local anesthetic because the treatment for local anesthetic toxicity is intralipid, and Exparel is already in intralipid. ↗
▶ Ep 7 · 10:43
clinical In Cincinnati's donor nephrectomy experience with Exparel TAP blocks, patients go off PCA one day earlier, have less opioid-related adverse effects, and use less opioids. ↗
▶ Ep 7 · 10:52
guideline Exparel is not approved for pediatric use by the FDA. ↗
▶ Ep 7 · 12:05
clinical Cincinnati allows patients with epidurals to walk inside the room and outside with help; Foley catheters are removed the next day after surgery. ↗
▶ Ep 7 · 14:12
clinical Cincinnati's surgical pain service sees patients minimum 3 times daily (morning, afternoon, evening rounds) and is available 24/7. ↗
▶ Ep 7 · 15:58
host_summary There is evidence in medical literature that meditation benefits include minimizing pain, anxiety, and improving immune function after surgery. ↗
▶ Ep 7 · 18:00
epidemiological About 20-30% of pectus patients experience chronic persistent post-operative pain, defined as pain score of 3 or more two months after surgery. ↗
▶ Ep 7 · 19:50
clinical If a patient is on 5 days in a row of oxycodone or any other opioid, the risk of dependence goes up significantly. ↗
▶ Ep 7 · 19:50
quote If a child is on 5 days in a row of oxycodone or any other opioid, the risk of dependence goes up significantly ↗
▶ Ep 7 · 21:42
host_summary A meta-analysis of 6 studies published last year found that compared to PCA, epidural provided better pain control the first 2 days after pectus repair. ↗
▶ Ep 7 · 22:19
host_summary Two studies from Kansas with 22% and 35% epidural failure rates showed epidural didn't help relieve pain as well as PCA, likely due to poor epidural placement success. ↗
▶ Ep 7 · 23:13
clinical Cincinnati takes 10-15 minutes to place an epidural and achieves more than 95% success rate. ↗
▶ Ep 7 · 23:28
clinical With a good working epidural, Cincinnati sees zero pain scores immediately after surgery in the first 2-3 days, which was unheard of 10-15 years ago. ↗
▶ Ep 7 · 23:28
quote 10 years ago or 15 years ago it was not heard of zero pain after a major Pal surgery ↗
▶ Ep 7 · 23:46
clinical Cincinnati uses local anesthetic-only epidural solution which does not cause urinary retention and is very dermatomal, blocking only thoracic dermatomes. ↗
▶ Ep 7 · 24:18
clinical Most Cincinnati pectus patients go home on the 3rd or 4th day after surgery. ↗
▶ Ep 7 · 25:02
clinical Cincinnati's epidural success rate is more than 95%, and the number of patients needing PCA on top of epidural is now less than 5% (was 14% in 2013). ↗
▶ Ep 7 · 25:45
host_summary There is evidence that if you give pregabalin or gabapentin one hour before surgery, it decreases pain after surgery significantly and need for opioid is significantly less. ↗
▶ Ep 7 · 27:10
clinical Cincinnati uses IV methadone at lower doses (5 mg max) than adults (15-20 mg) because higher doses caused too much sedation in teenage pectus patients. ↗
▶ Ep 7 · 28:19
clinical Methadone can cause prolongation of QT interval with reports of ventricular arrhythmias, so Cincinnati monitors with EKG to ensure QT doesn't exceed 480 milliseconds. ↗
▶ Ep 7 · 28:47
quote In our experience, the number of patients needing any IV opioid in the 1st 2 or 3 days when they have epidural is less than 5% now ↗
▶ Ep 7 · 28:47
clinical The number of Cincinnati patients needing any IV opioid in the first 2-3 days when they have epidural is less than 5%. ↗
▶ Ep 7 · 31:27
clinical Cincinnati stops epidurals at 6 AM on post-op day 3 without weaning (from 8 mL/hour to zero immediately). ↗
▶ Ep 7 · 31:56
opinion The advantage of not using opioids in epidural solution is minimal; opioids cause more problems (itching, urinary retention) than benefit. Clonidine can provide the same pain relief without those side effects. ↗
▶ Ep 7 · 32:22
clinical Cincinnati uses high concentration ropivacaine (0.2%) for epidural; lower concentrations (0.12% or 0.15%) don't provide adequate pain relief. ↗
▶ Ep 7 · 35:14
epidemiological About 50% of Cincinnati's pectus patients get constipation the moment oxycodone is started. ↗
▶ Ep 7 · 35:21
clinical Naloxegol is a medication similar to naloxone that doesn't cross the blood-brain barrier, so it relieves opioid-induced constipation without reversing analgesia. ↗
▶ Ep 7 · 36:52
clinical In spine surgery patients (equally or less painful than pectus) who get PCA instead of epidural, about 15% have respiratory depression (respiratory rate <8, oxygen saturation <90%) despite multimodal analgesia. ↗
▶ Ep 7 · 41:13
host_summary There is evidence that if you use even one dose of methadone in the OR, it cuts back on opioid use significantly and improves pain control in the next two days. ↗
▶ Ep 7 · 41:43
epidemiological Thoracic surgery including pectus is considered high risk for persistent post-operative pain; about 20-30% of pectus patients develop chronic pain (pain score >3 at 2 months post-op). ↗
▶ Ep 7 · 42:08
host_summary Children and young adults have higher risk of persistent post-operative pain than elderly patients. ↗
▶ Ep 7 · 42:41
clinical When pain is managed without regional anesthesia, the barrage of noxious stimuli to the brain precipitates neuroplasticity, causing the brain to remember pain long-term (6-12 months after surgery). ↗
▶ Ep 7 · 43:17
clinical Higher amounts of preoperative opioid use increase the risk for persistent pain; high opioid doses turn down opioid receptor genes, which is connected with persistent pain. ↗
▶ Ep 7 · 43:48
host_summary Seattle studies show that if a child doesn't sleep well before surgery (disturbed sleep, short duration), they are at high risk for persistent pain. ↗
▶ Ep 7 · 44:26
clinical Cincinnati performs preoperative CYP2D6 genetic testing; saliva or blood sample taken at surgical clinic, results available in EPIC within 2 days, covered by most insurance. ↗
▶ Ep 7 · 44:26
clinical CYP2D6 is the major liver enzyme that metabolizes most oral opioids including codeine, tramadol, oxycodone, and hydrocodone. ↗
▶ Ep 7 · 45:02
host_summary There is evidence that codeine, tramadol, and hydrocodone are not safe in ultra-rapid metabolizers. ↗
▶ Ep 7 · 45:44
clinical Ultra-rapid metabolizers are not good candidates for codeine, tramadol, or hydrocodone, but they are okay with morphine and hydromorphone. ↗
▶ Ep 7 · 48:27
clinical Cincinnati can reliably predict who will have respiratory depression by looking at their genes and genetic signature. ↗
▶ Ep 7 · 49:38
epidemiological In Cincinnati population, only 1-2% are ultra-rapid metabolizers; in African American and especially Ethiopian populations, ultra-rapid metabolizers can be as high as 29%. ↗
▶ Ep 7 · 50:00
guideline The FDA has warned against use of codeine following tonsillectomy; tramadol and hydrocodone warnings are under FDA review. ↗
▶ Ep 7 · 50:13
clinical Among currently available opioids, oxycodone is the least affected by CYP2D6 metabolism. ↗
▶ Ep 7 · 51:01
clinical Even extensive metabolizers (normal population) are at high risk for sedation and respiratory depression if they have coexisting morbidity like asthma or sleep apnea. ↗
▶ Ep 7 · 51:29
clinical Sedation always precedes respiratory depression; Cincinnati nurses monitor sedation using Ramsay sedation scale every shift to prevent respiratory depression. ↗
▶ Ep 7 · 52:02
clinical Cincinnati has not used naloxone for any pain patients in more than 3 years despite using maximum opioid amounts, attributed to aggressive monitoring. ↗
▶ Ep 7 · 52:23
clinical The 50-gene genetic panel costs $50; CYP2D6 testing costs less than $1 per gene. ↗
▶ Ep 7 · 52:42
clinical One gene (fatty acid amide hydrolase) associated with nausea, vomiting, and prolonged PACU stay saves more than $100 per patient when used to guide dosing, exceeding the cost of genotyping. ↗
▶ Ep 7 · 53:23
opinion Intercostal blocks are still good and better than nothing for preemptive pain control, but may miss one or two intercostal nerves and don't provide pain relief as good as epidural. ↗
▶ Ep 7 · 53:44
clinical Higher concentration of local anesthetic is better for preemptive analgesia, which is why Cincinnati places epidurals before surgery with high-concentration ropivacaine. ↗
Pectus Excavatum 244 entries

Pectus Excavatum Pain Management at Cincinnati Children's Hospital

▶ Ep 6 · 0:29
opinion Nothing is as good as epidural analgesia for pectus patients; On-Q pumps come second to epidural in Cincinnati's experience. ↗
▶ Ep 6 · 0:29
quote nothing is as good as epidural analogiesia for Pus patients. Oncup pumps comes second to epidural in our experience ↗
▶ Ep 6 · 0:29
quote nothing is as good as epidural analogiesia for Pus patients. Oncup pumps comes second to epidural in our experience ↗
▶ Ep 6 · 0:29
opinion Nothing is as good as epidural analgesia for pectus patients; On-Q pumps come second to epidural in Cincinnati's experience. ↗
▶ Ep 6 · 0:45
host_summary Seattle Children's Hospital, which transitioned from epidural to On-Q pumps, is experiencing issues with pain management. ↗
▶ Ep 6 · 0:45
clinical Seattle Children's Hospital, which transitioned from epidural to On-Q pumps, is experiencing issues with pain management. ↗
▶ Ep 6 · 1:28
clinical More than 95% of Cincinnati's pectus patients do not receive PCA along with epidural. ↗
▶ Ep 6 · 1:28
quote more than 95% of our patients do not get a PCA along with epidural, which says a lot about how we manage our epidural ↗
▶ Ep 6 · 1:28
clinical More than 95% of Cincinnati's pectus patients do not receive PCA along with epidural. ↗
▶ Ep 6 · 1:28
quote more than 95% of our patients do not get a PCA along with epidural, which says a lot about how we manage our epidural ↗
▶ Ep 6 · 1:38
clinical The pain team sees pectus patients at least 3 times per day and tweaks epidural rate or position to optimize analgesia. ↗
▶ Ep 6 · 1:38
clinical The pain team sees pectus patients at least 3 times per day and tweaks epidural rate or position to optimize analgesia. ↗
▶ Ep 6 · 2:04
clinical More than 99% of Cincinnati's pectus patients receive epidural analgesia. ↗
▶ Ep 6 · 2:04
clinical More than 99% of Cincinnati's pectus patients receive epidural analgesia. ↗
▶ Ep 6 · 2:24
clinical Older patients and young adults have more pain after pectus repair due to chest wall rigidity. ↗
▶ Ep 6 · 2:24
clinical Older patients and young adults have more pain after pectus repair due to chest wall rigidity. ↗
▶ Ep 6 · 2:35
clinical Patients with Ehlers-Danlos syndrome have extensive pain and may have pain even before surgery. ↗
▶ Ep 6 · 2:35
clinical Patients with Ehlers-Danlos syndrome have extensive pain and may have pain even before surgery. ↗
▶ Ep 6 · 2:49
clinical Patients with psychological problems like depression and excessive anxiety benefit from On-Q pumps in addition to epidural. ↗
▶ Ep 6 · 2:49
clinical Patients with psychological problems like depression and excessive anxiety benefit from On-Q pumps in addition to epidural. ↗
▶ Ep 6 · 2:58
clinical Patients with family history of substance abuse benefit from minimizing opioid use through epidural and On-Q pump. ↗
▶ Ep 6 · 2:58
clinical Patients with family history of substance abuse benefit from minimizing opioid use through epidural and On-Q pump. ↗
▶ Ep 6 · 3:29
clinical Pain catastrophization (anticipating negative outcomes) in children or parents is associated with more postoperative pain. ↗
▶ Ep 6 · 3:29
clinical Pain catastrophization (anticipating negative outcomes) in children or parents is associated with more postoperative pain. ↗
▶ Ep 6 · 4:25
clinical Two major risks with epidural are injury during placement (including paraplegia) and infection (epidural abscess) if the catheter is left too long. ↗
▶ Ep 6 · 4:25
clinical Two major risks with epidural are injury during placement (including paraplegia) and infection (epidural abscess) if the catheter is left too long. ↗
▶ Ep 6 · 4:50
clinical Cincinnati places epidurals in awake patients with minimal sedation in sitting position to minimize risk of traumatic placement. ↗
▶ Ep 6 · 4:50
clinical Cincinnati places epidurals in awake patients with minimal sedation in sitting position to minimize risk of traumatic placement. ↗
▶ Ep 6 · 5:24
clinical Cincinnati removes epidural catheters on the 3rd day after surgery to prevent epidural abscess. ↗
▶ Ep 6 · 5:24
clinical Cincinnati removes epidural catheters on the 3rd day after surgery to prevent epidural abscess. ↗
▶ Ep 6 · 5:30
clinical Most neurological injury from epidural in children is from hypoperfusion of the spinal cord, not traumatic placement. ↗
▶ Ep 6 · 5:30
clinical Most neurological injury from epidural in children is from hypoperfusion of the spinal cord, not traumatic placement. ↗
▶ Ep 6 · 5:49
clinical Cincinnati aggressively manages blood pressure to maintain spinal cord perfusion, reducing epidural rate and removing clonidine if blood pressure is low. ↗
▶ Ep 6 · 5:49
clinical Cincinnati aggressively manages blood pressure to maintain spinal cord perfusion, reducing epidural rate and removing clonidine if blood pressure is low. ↗
▶ Ep 6 · 10:32
clinical Exparel (liposomal bupivacaine) is safer than plain local anesthetic because the treatment for local anesthetic toxicity is intralipid, which Exparel already contains. ↗
▶ Ep 6 · 10:32
clinical Exparel (liposomal bupivacaine) is safer than plain local anesthetic because the treatment for local anesthetic toxicity is intralipid, which Exparel already contains. ↗
▶ Ep 6 · 10:38
quote The treatment for a local anesthetic toxicity is intralipid. This medication is in the intralipid, so it is safer ↗
▶ Ep 6 · 10:38
quote The treatment for a local anesthetic toxicity is intralipid. This medication is in the intralipid, so it is safer ↗
▶ Ep 6 · 10:49
clinical In Cincinnati's donor nephrectomy experience with Exparel TAP blocks, patients discontinue PCA one day earlier and use fewer opioids with fewer side effects. ↗
▶ Ep 6 · 10:49
clinical In Cincinnati's donor nephrectomy experience with Exparel TAP blocks, patients discontinue PCA one day earlier and use fewer opioids with fewer side effects. ↗
▶ Ep 6 · 11:01
guideline Exparel is not FDA-approved for pediatric use. ↗
▶ Ep 6 · 11:01
guideline Exparel is not FDA-approved for pediatric use. ↗
▶ Ep 6 · 12:05
clinical Cincinnati allows patients with epidurals to walk inside the room and even outside with help because there are no narcotics in the epidural solution. ↗
▶ Ep 6 · 12:05
clinical Cincinnati allows patients with epidurals to walk inside the room and even outside with help because there are no narcotics in the epidural solution. ↗
▶ Ep 6 · 12:17
clinical Cincinnati removes Foley catheters the day after surgery and allows ambulation, which epidural facilitates. ↗
▶ Ep 6 · 12:17
clinical Cincinnati removes Foley catheters the day after surgery and allows ambulation, which epidural facilitates. ↗
▶ Ep 6 · 14:36
clinical Cincinnati's preoperative preparation includes mandatory pain education by a pain nurse 2-3 months before surgery and optional genetic research for opioid risk. ↗
▶ Ep 6 · 14:36
clinical Cincinnati's preoperative preparation includes mandatory pain education by a pain nurse 2-3 months before surgery and optional genetic research for opioid risk. ↗
▶ Ep 6 · 15:58
clinical Medical literature shows meditation benefits include minimizing pain, anxiety, and improving immune function after surgery. ↗
▶ Ep 6 · 15:58
host_summary Medical literature shows meditation benefits include minimizing pain, anxiety, and improving immune function after surgery. ↗
▶ Ep 6 · 18:00
epidemiological About 20-30% of pectus patients experience chronic persistent post-operative pain, defined as pain score of 3 or more two months after surgery. ↗
▶ Ep 6 · 18:00
epidemiological About 20-30% of pectus patients experience chronic persistent post-operative pain, defined as pain score of 3 or more two months after surgery. ↗
▶ Ep 6 · 18:35
clinical Opioids have a narrow therapeutic index: beyond a certain dose they will not relieve pain but can cause significant side effects. ↗
▶ Ep 6 · 18:35
clinical Opioids have a narrow therapeutic index: beyond a certain dose they will not relieve pain but can cause significant side effects. ↗
▶ Ep 6 · 19:24
clinical Strong adult literature shows that regional analgesia (epidural or On-Q pump) reduces persistent post-operative pain, including after thoracotomy. ↗
▶ Ep 6 · 19:24
host_summary Strong adult literature shows that regional analgesia (epidural or On-Q pump) reduces persistent post-operative pain, including after thoracotomy. ↗
▶ Ep 6 · 19:50
clinical If a child is on 5 consecutive days of oxycodone or any other opioid, the risk of dependence increases significantly. ↗
▶ Ep 6 · 19:50
clinical If a child is on 5 consecutive days of oxycodone or any other opioid, the risk of dependence increases significantly. ↗
▶ Ep 6 · 21:42
host_summary A 2023 meta-analysis of 6 studies comparing epidural to PCA for pectus repair found epidural provided better pain control in the first 2 days. ↗
▶ Ep 6 · 21:42
clinical A 2023 meta-analysis of 6 studies comparing epidural to PCA for pectus repair found epidural provided better pain control in the first 2 days. ↗
▶ Ep 6 · 22:19
host_summary Two studies from Kansas had epidural failure rates of 22% and 35%, likely explaining why epidural didn't provide superior pain relief in those studies. ↗
▶ Ep 6 · 22:19
clinical Two studies from Kansas had epidural failure rates of 22% and 35%, likely explaining why epidural didn't provide superior pain relief in those studies. ↗
▶ Ep 6 · 23:28
clinical With good epidural function, Cincinnati achieves zero pain scores immediately after pectus surgery in the first 2-3 days, which was unheard of 10-15 years ago. ↗
▶ Ep 6 · 23:28
clinical With good epidural function, Cincinnati achieves zero pain scores immediately after pectus surgery in the first 2-3 days, which was unheard of 10-15 years ago. ↗
▶ Ep 6 · 23:58
clinical Cincinnati uses local anesthetic-only epidural solution (no opioids), which does not cause urinary retention and is very dermatomal, blocking only thoracic dermatomes. ↗
▶ Ep 6 · 23:58
clinical Cincinnati uses local anesthetic-only epidural solution (no opioids), which does not cause urinary retention and is very dermatomal, blocking only thoracic dermatomes. ↗
▶ Ep 6 · 24:18
clinical Most Cincinnati pectus patients are discharged on the 3rd or 4th day after surgery. ↗
▶ Ep 6 · 24:18
clinical Most Cincinnati pectus patients are discharged on the 3rd or 4th day after surgery. ↗
▶ Ep 6 · 25:02
clinical Cincinnati's epidural success rate is more than 95%, with less than 5% of patients needing PCA on top of epidural (down from 14% in 2013). ↗
▶ Ep 6 · 25:02
clinical Cincinnati's epidural success rate is more than 95%, with less than 5% of patients needing PCA on top of epidural (down from 14% in 2013). ↗
▶ Ep 6 · 25:31
clinical Cincinnati uses IV methadone intraoperatively and for the first 2 days; literature shows even one intraoperative dose significantly decreases pain and opioid use for 2 days. ↗
▶ Ep 6 · 25:31
clinical Cincinnati uses IV methadone intraoperatively and for the first 2 days; literature shows even one intraoperative dose significantly decreases pain and opioid use for 2 days. ↗
▶ Ep 6 · 25:45
clinical Cincinnati uses pregabalin preoperatively; literature shows that giving pregabalin or gabapentin one hour before surgery significantly decreases postoperative pain and opioid need. ↗
▶ Ep 6 · 25:45
clinical Cincinnati uses pregabalin preoperatively; literature shows that giving pregabalin or gabapentin one hour before surgery significantly decreases postoperative pain and opioid need. ↗
▶ Ep 6 · 27:15
clinical Cincinnati reduced methadone dose from 15-20 mg (adult dose) to 5 mg maximum in teenagers due to excessive sedation with higher doses combined with pregabalin and anesthesia. ↗
▶ Ep 6 · 27:15
clinical Cincinnati reduced methadone dose from 15-20 mg (adult dose) to 5 mg maximum in teenagers due to excessive sedation with higher doses combined with pregabalin and anesthesia. ↗
▶ Ep 6 · 27:42
clinical Cincinnati uses IV methocarbamol routinely for muscle spasms after pectus surgery, which reduces the need for IV diazepam. ↗
▶ Ep 6 · 27:42
clinical Cincinnati uses IV methocarbamol routinely for muscle spasms after pectus surgery, which reduces the need for IV diazepam. ↗
▶ Ep 6 · 28:19
clinical Methadone can cause QT interval prolongation; Cincinnati performs baseline EKG preoperatively and post-op day 1 EKG to ensure QT doesn't exceed 480 milliseconds. ↗
▶ Ep 6 · 28:19
clinical Methadone can cause QT interval prolongation; Cincinnati performs baseline EKG preoperatively and post-op day 1 EKG to ensure QT doesn't exceed 480 milliseconds. ↗
▶ Ep 6 · 28:36
clinical Cincinnati alternates IV ketorolac every 6 hours with IV acetaminophen to minimize opioid use. ↗
▶ Ep 6 · 28:36
clinical Cincinnati alternates IV ketorolac every 6 hours with IV acetaminophen to minimize opioid use. ↗
▶ Ep 6 · 28:47
clinical Less than 5% of Cincinnati's pectus patients need any IV opioid in the first 2-3 days when they have epidural. ↗
▶ Ep 6 · 28:47
clinical Less than 5% of Cincinnati's pectus patients need any IV opioid in the first 2-3 days when they have epidural. ↗
▶ Ep 6 · 29:10
clinical Cincinnati delays starting oxycodone until post-op day 2 when possible to minimize opioid exposure. ↗
▶ Ep 6 · 29:10
clinical Cincinnati delays starting oxycodone until post-op day 2 when possible to minimize opioid exposure. ↗
▶ Ep 6 · 30:10
clinical For selected high-risk patients, Cincinnati places subcutaneous intercostal On-Q catheters, starting at 1 mL/hour per side with epidural, then increasing to 4-6 mL/hour per side after epidural removal. ↗
▶ Ep 6 · 30:10
clinical For selected high-risk patients, Cincinnati places subcutaneous intercostal On-Q catheters, starting at 1 mL/hour per side with epidural, then increasing to 4-6 mL/hour per side after epidural removal. ↗
▶ Ep 6 · 31:27
clinical Cincinnati stops epidural abruptly at 6 AM on post-op day 3 without weaning. ↗
▶ Ep 6 · 31:27
clinical Cincinnati stops epidural abruptly at 6 AM on post-op day 3 without weaning. ↗
▶ Ep 6 · 32:02
clinical The advantage of not using opioids in epidural solution is minimal; opioids cause more problems (itching, urinary retention) than benefits. Clonidine provides the same pain relief benefits without these side effects. ↗
▶ Ep 6 · 32:02
clinical The advantage of not using opioids in epidural solution is minimal; opioids cause more problems (itching, urinary retention) than benefits. Clonidine provides the same pain relief benefits without these side effects. ↗
▶ Ep 6 · 32:22
clinical Cincinnati uses high concentration ropivacaine (0.2%) in epidural solution for good pain control; lower concentrations (0.12% or 0.15%) don't provide adequate pain relief. ↗
▶ Ep 6 · 32:22
clinical Cincinnati uses high concentration ropivacaine (0.2%) in epidural solution for good pain control; lower concentrations (0.12% or 0.15%) don't provide adequate pain relief. ↗
▶ Ep 6 · 35:14
clinical About 50% of patients on oxycodone develop opioid-induced constipation. ↗
▶ Ep 6 · 35:14
clinical About 50% of patients on oxycodone develop opioid-induced constipation. ↗
▶ Ep 6 · 35:22
clinical Naloxegol is similar to naloxone but doesn't cross the blood-brain barrier, so it relieves opioid-induced constipation without reversing analgesia. ↗
▶ Ep 6 · 35:22
clinical Naloxegol is similar to naloxone but doesn't cross the blood-brain barrier, so it relieves opioid-induced constipation without reversing analgesia. ↗
▶ Ep 6 · 35:25
clinical Naloxegol is FDA-approved for opioid-induced constipation but not yet approved for pediatric use; Cincinnati uses it off-label. ↗
▶ Ep 6 · 35:25
clinical Naloxegol is FDA-approved for opioid-induced constipation but not yet approved for pediatric use; Cincinnati uses it off-label. ↗
▶ Ep 6 · 36:52
clinical In spine surgery patients receiving PCA (without epidural), about 15% experience respiratory depression defined as respiratory rate less than 8 breaths per minute and oxygen saturation less than 90%. ↗
▶ Ep 6 · 36:52
clinical In spine surgery patients receiving PCA (without epidural), about 15% experience respiratory depression defined as respiratory rate less than 8 breaths per minute and oxygen saturation less than 90%. ↗
▶ Ep 6 · 37:49
clinical Tramadol is similar to codeine; about 80-85% of the population are intermediate or extensive metabolizers with good pain control, 10-12% are poor metabolizers with inadequate pain relief, and 1-2% are ultra-rapid metabolizers at risk for respiratory depression and death. ↗
▶ Ep 6 · 37:49
clinical Tramadol is similar to codeine; about 80-85% of the population are intermediate or extensive metabolizers with good pain control, 10-12% are poor metabolizers with inadequate pain relief, and 1-2% are ultra-rapid metabolizers at risk for respiratory depression and death. ↗
▶ Ep 6 · 49:45
epidemiological In Ethiopian populations, ultra-rapid metabolizers can be as high as 29%, compared to 1-2% in Cincinnati's population. ↗
▶ Ep 6 · 49:45
epidemiological In Ethiopian populations, ultra-rapid metabolizers can be as high as 29%, compared to 1-2% in Cincinnati's population. ↗
▶ Ep 6 · 50:00
guideline The FDA has warned against use of codeine following tonsillectomy; warnings for tramadol and hydrocodone are under FDA review. ↗
▶ Ep 6 · 50:00
guideline The FDA has warned against use of codeine following tonsillectomy; warnings for tramadol and hydrocodone are under FDA review. ↗
▶ Ep 6 · 50:13
clinical Among currently available opioids, oxycodone is the least affected by CYP2D6 metabolism. ↗
▶ Ep 6 · 50:13
clinical Among currently available opioids, oxycodone is the least affected by CYP2D6 metabolism. ↗
▶ Ep 6 · 50:29
clinical Cincinnati avoids oxycodone in ultra-rapid metabolizers and uses oral hydromorphone (Dilaudid) instead. ↗
▶ Ep 6 · 50:29
clinical Cincinnati avoids oxycodone in ultra-rapid metabolizers and uses oral hydromorphone (Dilaudid) instead. ↗
▶ Ep 6 · 51:01
clinical Even extensive metabolizers (normal population) with comorbidities like asthma or sleep apnea are at high risk for sedation and respiratory depression, so Cincinnati reduces oxycodone doses in these patients. ↗
▶ Ep 6 · 51:01
clinical Even extensive metabolizers (normal population) with comorbidities like asthma or sleep apnea are at high risk for sedation and respiratory depression, so Cincinnati reduces oxycodone doses in these patients. ↗
▶ Ep 6 · 51:29
clinical Sedation always precedes respiratory depression; Cincinnati nurses monitor sedation using Ramsay sedation scale every shift to prevent respiratory depression. ↗
▶ Ep 6 · 51:29
clinical Sedation always precedes respiratory depression; Cincinnati nurses monitor sedation using Ramsay sedation scale every shift to prevent respiratory depression. ↗
▶ Ep 6 · 51:44
clinical Cincinnati monitors end-tidal carbon dioxide continuously for the first 24 hours after pectus surgery. ↗
▶ Ep 6 · 51:44
clinical Cincinnati monitors end-tidal carbon dioxide continuously for the first 24 hours after pectus surgery. ↗
▶ Ep 6 · 52:02
clinical Cincinnati has not used naloxone for any pain patients in more than 3 years. ↗
▶ Ep 6 · 52:02
clinical Cincinnati has not used naloxone for any pain patients in more than 3 years. ↗
▶ Ep 6 · 52:23
clinical Cincinnati's 50-gene panel costs $50 (less than $1 per gene) and is covered by most insurance companies. ↗
▶ Ep 6 · 52:23
clinical Cincinnati's 50-gene panel costs $50 (less than $1 per gene) and is covered by most insurance companies. ↗
▶ Ep 6 · 52:42
clinical Cost-benefit analysis for one gene (fatty acid amide hydrolase) associated with nausea, vomiting, and prolonged PACU stay shows savings of more than $100 per patient when genotype-guided dosing is used. ↗
▶ Ep 6 · 52:42
clinical Cost-benefit analysis for one gene (fatty acid amide hydrolase) associated with nausea, vomiting, and prolonged PACU stay shows savings of more than $100 per patient when genotype-guided dosing is used. ↗
▶ Ep 6 · 53:24
clinical Intercostal blocks are better than nothing for preemptive analgesia but may miss one or two intercostal nerves, making them less effective than epidural. ↗
▶ Ep 6 · 53:24
clinical Intercostal blocks are better than nothing for preemptive analgesia but may miss one or two intercostal nerves, making them less effective than epidural. ↗
▶ Ep 6 · 53:44
clinical Cincinnati places all epidurals before surgical incision using high-concentration local anesthetic (0.2% ropivacaine) for optimal preemptive analgesia, balancing efficacy against hypotension risk. ↗
▶ Ep 6 · 53:44
clinical Cincinnati places all epidurals before surgical incision using high-concentration local anesthetic (0.2% ropivacaine) for optimal preemptive analgesia, balancing efficacy against hypotension risk. ↗

Pain Management: Pectus Innovations

▶ Ep 11 · 0:29
opinion Nothing is as good as epidural analgesia for pectus patients; On-Q pumps come second to epidural. ↗
▶ Ep 11 · 0:29
quote nothing is as good as epidural analogies here for Pus patients. Onup pumps come second to epidural in our experience ↗
▶ Ep 11 · 0:29
opinion Nothing is as good as epidural analgesia for pectus patients; On-Q pumps come second to epidural. ↗
▶ Ep 11 · 0:29
quote nothing is as good as epidural analogies here for Pus patients. Onup pumps come second to epidural in our experience ↗
▶ Ep 11 · 0:45
host_summary Seattle Children's Hospital has gone from epidural to On-Q pump recently and is having some issues. ↗
▶ Ep 11 · 0:45
clinical Seattle Children's Hospital has gone from epidural to On-Q pump recently and is having some issues. ↗
▶ Ep 11 · 1:28
clinical More than 95% of Cincinnati's pectus patients do not get a PCA along with epidural. ↗
▶ Ep 11 · 1:28
clinical More than 95% of Cincinnati's pectus patients do not get a PCA along with epidural. ↗
▶ Ep 11 · 1:28
quote more than 95% of our patients do not get a PCA along with epidural, which says a lot about how we manage our epidural ↗
▶ Ep 11 · 1:28
quote more than 95% of our patients do not get a PCA along with epidural, which says a lot about how we manage our epidural ↗
▶ Ep 11 · 2:24
clinical Older patients and young adults have more pain after pectus repair because of chest wall rigidity. ↗
▶ Ep 11 · 2:24
clinical Older patients and young adults have more pain after pectus repair because of chest wall rigidity. ↗
▶ Ep 11 · 2:35
clinical Patients with Ehlers-Danlos syndrome have extensive pain and often have pain even before surgery. ↗
▶ Ep 11 · 2:35
clinical Patients with Ehlers-Danlos syndrome have extensive pain and often have pain even before surgery. ↗
▶ Ep 11 · 3:29
host_summary Recent literature shows that if a child and their parent have pain catastrophization (anticipating negative outcomes), they are more likely to have more pain after surgery. ↗
▶ Ep 11 · 3:29
clinical Recent literature shows that if a child and their parent have pain catastrophization (anticipating negative outcomes), they are more likely to have more pain after surgery. ↗
▶ Ep 11 · 5:30
clinical Most neurological risk with epidural in children is from hypoperfusion of spinal cord, not from traumatic placement. ↗
▶ Ep 11 · 5:30
clinical Most neurological risk with epidural in children is from hypoperfusion of spinal cord, not from traumatic placement. ↗
▶ Ep 11 · 10:31
clinical Exparel (liposomal bupivacaine) is safer than plain local anesthetic because the treatment for local anesthetic toxicity is intralipid, and Exparel is already in intralipid. ↗
▶ Ep 11 · 10:31
clinical Exparel (liposomal bupivacaine) is safer than plain local anesthetic because the treatment for local anesthetic toxicity is intralipid, and Exparel is already in intralipid. ↗
▶ Ep 11 · 10:43
clinical In Cincinnati's donor nephrectomy experience with Exparel TAP blocks, patients go off PCA one day earlier, have less opioid-related adverse effects, and use less opioids. ↗
▶ Ep 11 · 10:43
clinical In Cincinnati's donor nephrectomy experience with Exparel TAP blocks, patients go off PCA one day earlier, have less opioid-related adverse effects, and use less opioids. ↗
▶ Ep 11 · 10:52
guideline Exparel is not approved for pediatric use by the FDA. ↗
▶ Ep 11 · 10:52
guideline Exparel is not approved for pediatric use by the FDA. ↗
▶ Ep 11 · 12:05
clinical Cincinnati allows patients with epidurals to walk inside the room and outside with help; Foley catheters are removed the next day after surgery. ↗
▶ Ep 11 · 12:05
clinical Cincinnati allows patients with epidurals to walk inside the room and outside with help; Foley catheters are removed the next day after surgery. ↗
▶ Ep 11 · 14:12
clinical Cincinnati's surgical pain service sees patients minimum 3 times daily (morning, afternoon, evening rounds) and is available 24/7. ↗
▶ Ep 11 · 14:12
clinical Cincinnati's surgical pain service sees patients minimum 3 times daily (morning, afternoon, evening rounds) and is available 24/7. ↗
▶ Ep 11 · 15:58
clinical There is evidence in medical literature that meditation benefits include minimizing pain, anxiety, and improving immune function after surgery. ↗
▶ Ep 11 · 15:58
host_summary There is evidence in medical literature that meditation benefits include minimizing pain, anxiety, and improving immune function after surgery. ↗
▶ Ep 11 · 18:00
epidemiological About 20-30% of pectus patients experience chronic persistent post-operative pain, defined as pain score of 3 or more two months after surgery. ↗
▶ Ep 11 · 18:00
epidemiological About 20-30% of pectus patients experience chronic persistent post-operative pain, defined as pain score of 3 or more two months after surgery. ↗
▶ Ep 11 · 19:50
clinical If a patient is on 5 days in a row of oxycodone or any other opioid, the risk of dependence goes up significantly. ↗
▶ Ep 11 · 19:50
quote If a child is on 5 days in a row of oxycodone or any other opioid, the risk of dependence goes up significantly ↗
▶ Ep 11 · 19:50
clinical If a patient is on 5 days in a row of oxycodone or any other opioid, the risk of dependence goes up significantly. ↗
▶ Ep 11 · 19:50
quote If a child is on 5 days in a row of oxycodone or any other opioid, the risk of dependence goes up significantly ↗
▶ Ep 11 · 21:42
host_summary A meta-analysis of 6 studies published last year found that compared to PCA, epidural provided better pain control the first 2 days after pectus repair. ↗
▶ Ep 11 · 21:42
clinical A meta-analysis of 6 studies published last year found that compared to PCA, epidural provided better pain control the first 2 days after pectus repair. ↗
▶ Ep 11 · 22:19
clinical Two studies from Kansas with 22% and 35% epidural failure rates showed epidural didn't help relieve pain as well as PCA, likely due to poor epidural placement success. ↗
▶ Ep 11 · 22:19
host_summary Two studies from Kansas with 22% and 35% epidural failure rates showed epidural didn't help relieve pain as well as PCA, likely due to poor epidural placement success. ↗
▶ Ep 11 · 23:13
clinical Cincinnati takes 10-15 minutes to place an epidural and achieves more than 95% success rate. ↗
▶ Ep 11 · 23:13
clinical Cincinnati takes 10-15 minutes to place an epidural and achieves more than 95% success rate. ↗
▶ Ep 11 · 23:28
clinical With a good working epidural, Cincinnati sees zero pain scores immediately after surgery in the first 2-3 days, which was unheard of 10-15 years ago. ↗
▶ Ep 11 · 23:28
quote 10 years ago or 15 years ago it was not heard of zero pain after a major Pal surgery ↗
▶ Ep 11 · 23:28
clinical With a good working epidural, Cincinnati sees zero pain scores immediately after surgery in the first 2-3 days, which was unheard of 10-15 years ago. ↗
▶ Ep 11 · 23:28
quote 10 years ago or 15 years ago it was not heard of zero pain after a major Pal surgery ↗
▶ Ep 11 · 23:46
clinical Cincinnati uses local anesthetic-only epidural solution which does not cause urinary retention and is very dermatomal, blocking only thoracic dermatomes. ↗
▶ Ep 11 · 23:46
clinical Cincinnati uses local anesthetic-only epidural solution which does not cause urinary retention and is very dermatomal, blocking only thoracic dermatomes. ↗
▶ Ep 11 · 24:18
clinical Most Cincinnati pectus patients go home on the 3rd or 4th day after surgery. ↗
▶ Ep 11 · 24:18
clinical Most Cincinnati pectus patients go home on the 3rd or 4th day after surgery. ↗
▶ Ep 11 · 25:02
clinical Cincinnati's epidural success rate is more than 95%, and the number of patients needing PCA on top of epidural is now less than 5% (was 14% in 2013). ↗
▶ Ep 11 · 25:02
clinical Cincinnati's epidural success rate is more than 95%, and the number of patients needing PCA on top of epidural is now less than 5% (was 14% in 2013). ↗
▶ Ep 11 · 25:45
clinical There is evidence that if you give pregabalin or gabapentin one hour before surgery, it decreases pain after surgery significantly and need for opioid is significantly less. ↗
▶ Ep 11 · 25:45
host_summary There is evidence that if you give pregabalin or gabapentin one hour before surgery, it decreases pain after surgery significantly and need for opioid is significantly less. ↗
▶ Ep 11 · 27:10
clinical Cincinnati uses IV methadone at lower doses (5 mg max) than adults (15-20 mg) because higher doses caused too much sedation in teenage pectus patients. ↗
▶ Ep 11 · 27:10
clinical Cincinnati uses IV methadone at lower doses (5 mg max) than adults (15-20 mg) because higher doses caused too much sedation in teenage pectus patients. ↗
▶ Ep 11 · 28:19
clinical Methadone can cause prolongation of QT interval with reports of ventricular arrhythmias, so Cincinnati monitors with EKG to ensure QT doesn't exceed 480 milliseconds. ↗
▶ Ep 11 · 28:19
clinical Methadone can cause prolongation of QT interval with reports of ventricular arrhythmias, so Cincinnati monitors with EKG to ensure QT doesn't exceed 480 milliseconds. ↗
▶ Ep 11 · 28:47
quote In our experience, the number of patients needing any IV opioid in the 1st 2 or 3 days when they have epidural is less than 5% now ↗
▶ Ep 11 · 28:47
clinical The number of Cincinnati patients needing any IV opioid in the first 2-3 days when they have epidural is less than 5%. ↗
▶ Ep 11 · 28:47
quote In our experience, the number of patients needing any IV opioid in the 1st 2 or 3 days when they have epidural is less than 5% now ↗
▶ Ep 11 · 28:47
clinical The number of Cincinnati patients needing any IV opioid in the first 2-3 days when they have epidural is less than 5%. ↗
▶ Ep 11 · 31:27
clinical Cincinnati stops epidurals at 6 AM on post-op day 3 without weaning (from 8 mL/hour to zero immediately). ↗
▶ Ep 11 · 31:27
clinical Cincinnati stops epidurals at 6 AM on post-op day 3 without weaning (from 8 mL/hour to zero immediately). ↗
▶ Ep 11 · 31:56
opinion The advantage of not using opioids in epidural solution is minimal; opioids cause more problems (itching, urinary retention) than benefit. Clonidine can provide the same pain relief without those side effects. ↗
▶ Ep 11 · 31:56
opinion The advantage of not using opioids in epidural solution is minimal; opioids cause more problems (itching, urinary retention) than benefit. Clonidine can provide the same pain relief without those side effects. ↗
▶ Ep 11 · 32:22
clinical Cincinnati uses high concentration ropivacaine (0.2%) for epidural; lower concentrations (0.12% or 0.15%) don't provide adequate pain relief. ↗
▶ Ep 11 · 32:22
clinical Cincinnati uses high concentration ropivacaine (0.2%) for epidural; lower concentrations (0.12% or 0.15%) don't provide adequate pain relief. ↗
▶ Ep 11 · 35:14
epidemiological About 50% of Cincinnati's pectus patients get constipation the moment oxycodone is started. ↗
▶ Ep 11 · 35:14
epidemiological About 50% of Cincinnati's pectus patients get constipation the moment oxycodone is started. ↗
▶ Ep 11 · 35:21
clinical Naloxegol is a medication similar to naloxone that doesn't cross the blood-brain barrier, so it relieves opioid-induced constipation without reversing analgesia. ↗
▶ Ep 11 · 35:21
clinical Naloxegol is a medication similar to naloxone that doesn't cross the blood-brain barrier, so it relieves opioid-induced constipation without reversing analgesia. ↗
▶ Ep 11 · 36:52
clinical In spine surgery patients (equally or less painful than pectus) who get PCA instead of epidural, about 15% have respiratory depression (respiratory rate <8, oxygen saturation <90%) despite multimodal analgesia. ↗
▶ Ep 11 · 36:52
clinical In spine surgery patients (equally or less painful than pectus) who get PCA instead of epidural, about 15% have respiratory depression (respiratory rate <8, oxygen saturation <90%) despite multimodal analgesia. ↗
▶ Ep 11 · 41:13
clinical There is evidence that if you use even one dose of methadone in the OR, it cuts back on opioid use significantly and improves pain control in the next two days. ↗
▶ Ep 11 · 41:13
host_summary There is evidence that if you use even one dose of methadone in the OR, it cuts back on opioid use significantly and improves pain control in the next two days. ↗
▶ Ep 11 · 41:43
epidemiological Thoracic surgery including pectus is considered high risk for persistent post-operative pain; about 20-30% of pectus patients develop chronic pain (pain score >3 at 2 months post-op). ↗
▶ Ep 11 · 41:43
epidemiological Thoracic surgery including pectus is considered high risk for persistent post-operative pain; about 20-30% of pectus patients develop chronic pain (pain score >3 at 2 months post-op). ↗
▶ Ep 11 · 42:08
host_summary Children and young adults have higher risk of persistent post-operative pain than elderly patients. ↗
▶ Ep 11 · 42:08
clinical Children and young adults have higher risk of persistent post-operative pain than elderly patients. ↗
▶ Ep 11 · 42:41
clinical When pain is managed without regional anesthesia, the barrage of noxious stimuli to the brain precipitates neuroplasticity, causing the brain to remember pain long-term (6-12 months after surgery). ↗
▶ Ep 11 · 42:41
clinical When pain is managed without regional anesthesia, the barrage of noxious stimuli to the brain precipitates neuroplasticity, causing the brain to remember pain long-term (6-12 months after surgery). ↗
▶ Ep 11 · 43:17
clinical Higher amounts of preoperative opioid use increase the risk for persistent pain; high opioid doses turn down opioid receptor genes, which is connected with persistent pain. ↗
▶ Ep 11 · 43:17
clinical Higher amounts of preoperative opioid use increase the risk for persistent pain; high opioid doses turn down opioid receptor genes, which is connected with persistent pain. ↗
▶ Ep 11 · 43:48
clinical Seattle studies show that if a child doesn't sleep well before surgery (disturbed sleep, short duration), they are at high risk for persistent pain. ↗
▶ Ep 11 · 43:48
host_summary Seattle studies show that if a child doesn't sleep well before surgery (disturbed sleep, short duration), they are at high risk for persistent pain. ↗
▶ Ep 11 · 44:26
clinical Cincinnati performs preoperative CYP2D6 genetic testing; saliva or blood sample taken at surgical clinic, results available in EPIC within 2 days, covered by most insurance. ↗
▶ Ep 11 · 44:26
clinical Cincinnati performs preoperative CYP2D6 genetic testing; saliva or blood sample taken at surgical clinic, results available in EPIC within 2 days, covered by most insurance. ↗
▶ Ep 11 · 44:26
clinical CYP2D6 is the major liver enzyme that metabolizes most oral opioids including codeine, tramadol, oxycodone, and hydrocodone. ↗
▶ Ep 11 · 44:26
clinical CYP2D6 is the major liver enzyme that metabolizes most oral opioids including codeine, tramadol, oxycodone, and hydrocodone. ↗
▶ Ep 11 · 45:02
host_summary There is evidence that codeine, tramadol, and hydrocodone are not safe in ultra-rapid metabolizers. ↗
▶ Ep 11 · 45:02
clinical There is evidence that codeine, tramadol, and hydrocodone are not safe in ultra-rapid metabolizers. ↗
▶ Ep 11 · 45:44
clinical Ultra-rapid metabolizers are not good candidates for codeine, tramadol, or hydrocodone, but they are okay with morphine and hydromorphone. ↗
▶ Ep 11 · 45:44
clinical Ultra-rapid metabolizers are not good candidates for codeine, tramadol, or hydrocodone, but they are okay with morphine and hydromorphone. ↗
▶ Ep 11 · 48:27
clinical Cincinnati can reliably predict who will have respiratory depression by looking at their genes and genetic signature. ↗
▶ Ep 11 · 48:27
clinical Cincinnati can reliably predict who will have respiratory depression by looking at their genes and genetic signature. ↗
▶ Ep 11 · 49:38
epidemiological In Cincinnati population, only 1-2% are ultra-rapid metabolizers; in African American and especially Ethiopian populations, ultra-rapid metabolizers can be as high as 29%. ↗
▶ Ep 11 · 49:38
epidemiological In Cincinnati population, only 1-2% are ultra-rapid metabolizers; in African American and especially Ethiopian populations, ultra-rapid metabolizers can be as high as 29%. ↗
▶ Ep 11 · 50:00
guideline The FDA has warned against use of codeine following tonsillectomy; tramadol and hydrocodone warnings are under FDA review. ↗
▶ Ep 11 · 50:00
guideline The FDA has warned against use of codeine following tonsillectomy; tramadol and hydrocodone warnings are under FDA review. ↗
▶ Ep 11 · 50:13
clinical Among currently available opioids, oxycodone is the least affected by CYP2D6 metabolism. ↗
▶ Ep 11 · 50:13
clinical Among currently available opioids, oxycodone is the least affected by CYP2D6 metabolism. ↗
▶ Ep 11 · 51:01
clinical Even extensive metabolizers (normal population) are at high risk for sedation and respiratory depression if they have coexisting morbidity like asthma or sleep apnea. ↗
▶ Ep 11 · 51:01
clinical Even extensive metabolizers (normal population) are at high risk for sedation and respiratory depression if they have coexisting morbidity like asthma or sleep apnea. ↗
▶ Ep 11 · 51:29
clinical Sedation always precedes respiratory depression; Cincinnati nurses monitor sedation using Ramsay sedation scale every shift to prevent respiratory depression. ↗
▶ Ep 11 · 51:29
clinical Sedation always precedes respiratory depression; Cincinnati nurses monitor sedation using Ramsay sedation scale every shift to prevent respiratory depression. ↗
▶ Ep 11 · 52:02
clinical Cincinnati has not used naloxone for any pain patients in more than 3 years despite using maximum opioid amounts, attributed to aggressive monitoring. ↗
▶ Ep 11 · 52:02
clinical Cincinnati has not used naloxone for any pain patients in more than 3 years despite using maximum opioid amounts, attributed to aggressive monitoring. ↗
▶ Ep 11 · 52:23
clinical The 50-gene genetic panel costs $50; CYP2D6 testing costs less than $1 per gene. ↗
▶ Ep 11 · 52:23
clinical The 50-gene genetic panel costs $50; CYP2D6 testing costs less than $1 per gene. ↗
▶ Ep 11 · 52:42
clinical One gene (fatty acid amide hydrolase) associated with nausea, vomiting, and prolonged PACU stay saves more than $100 per patient when used to guide dosing, exceeding the cost of genotyping. ↗
▶ Ep 11 · 52:42
clinical One gene (fatty acid amide hydrolase) associated with nausea, vomiting, and prolonged PACU stay saves more than $100 per patient when used to guide dosing, exceeding the cost of genotyping. ↗
▶ Ep 11 · 53:23
opinion Intercostal blocks are still good and better than nothing for preemptive pain control, but may miss one or two intercostal nerves and don't provide pain relief as good as epidural. ↗
▶ Ep 11 · 53:23
opinion Intercostal blocks are still good and better than nothing for preemptive pain control, but may miss one or two intercostal nerves and don't provide pain relief as good as epidural. ↗
▶ Ep 11 · 53:44
clinical Higher concentration of local anesthetic is better for preemptive analgesia, which is why Cincinnati places epidurals before surgery with high-concentration ropivacaine. ↗
▶ Ep 11 · 53:44
clinical Higher concentration of local anesthetic is better for preemptive analgesia, which is why Cincinnati places epidurals before surgery with high-concentration ropivacaine. ↗