For multimodal therapy, the best treatments are preoperative counseling. Gabapentin both pre and postoperatively, and then methadone, clonidine, bowel regimen medications, and anti-emetics.
Computational modeling showed that shorter flat bars have different stress points compared to traditionally U-shaped bars, with shorter bars having more pressure on the sternum and therefore being more stable.
For multimodal pain therapy, the best treatments are preoperative counseling, gabapentin both pre and postoperatively, and then methadone, clonidine, bowel regimen medications, and anti-emetics.
Gabapentin is most commonly given once pre-op then 200-300mg three times daily for up to one week post-op; pharmacokinetics suggest starting several days before operation for peak effect.
Multimodal pain control options include Tylenol, NSAIDs, precedex for gentle wake-up, dexamethasone for post-anesthetic nausea, and ketamine to avoid opioids.
clinicalGabapentin is most commonly given once pre-op then 200-300mg three times daily for up to one week post-op; pharmacokinetics suggest starting several days before operation for peak effect.↗
▶Ep 23 · 24:10
epidemiologicalIn Texas Children's study, 50% of patients still take opioids two weeks after Nuss procedure.↗
▶Ep 23 · 24:40
epidemiologicalIn past five years, hospital length of stay for Nuss procedures has been cut in half through protocol improvements.↗
▶Ep 23 · 25:20
clinicalIn Nebraska protocol without epidurals, catheters, or cryo, length of stay is under two days and patients are off opioids by one week.↗
▶Ep 23 · 26:00
epidemiologicalIn Texas Children's study, urinary retention was 8% in cryo group versus 34% in non-cryo group.↗
▶Ep 23 · 26:25
epidemiologicalBar flippage occurs almost eight times more commonly in cryo group, and allodynia/neuropathy occurs about six times more frequently in cryo group.↗
▶Ep 23 · 37:19
clinicalPilegaard technique uses shorter bars placed asymmetrically with right side covering two rib spaces and left side with single stabilizer, resulting in well below 1% bar flip rate.↗
▶Ep 23 · 38:10
clinicalComputational modeling shows flatter bars focus stress on sternum while bigger curved bars have parasitic forces causing unwanted horizontal and torque action at bar ends.↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 25 · 5:40
clinicalMultimodal pain control options include Tylenol, NSAIDs, precedex for gentle wake-up, dexamethasone for post-anesthetic nausea, and ketamine to avoid opioids.↗
▶Ep 25 · 5:40
clinicalMultimodal pain control options include Tylenol, NSAIDs, precedex for gentle wake-up, dexamethasone for post-anesthetic nausea, and ketamine to avoid opioids.↗
▶Ep 25 · 5:55
clinicalNon-pharmacologic multimodal approaches include child life specialists, mindfulness resources, and supportive physical therapists.↗
▶Ep 25 · 5:55
clinicalNon-pharmacologic multimodal approaches include child life specialists, mindfulness resources, and supportive physical therapists.↗
▶Ep 25 · 6:02
clinicalDr. Ponsky's best multimodal treatments are preoperative counseling, gabapentin both pre and postoperatively, methadone, clonidine, bowel regimen medications, and anti-emetics.↗
▶Ep 25 · 6:19
clinicalAt the institution where Dr. Wagner trained in Nebraska, Steve Rayner achieves length of stay under 2 days with patients off opioids by 1 week.↗
▶Ep 25 · 7:36
clinicalPhysics-minded surgeons created a computational model showing that shorter flat bars have more pressure on the sternum compared to traditionally U-shaped bars, making them more stable.↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 26 · 6:02
clinicalFor multimodal pain therapy, the best treatments are preoperative counseling, gabapentin both pre and postoperatively, and then methadone, clonidine, bowel regimen medications, and anti-emetics.↗
▶Ep 26 · 6:02
quoteFor multimodal therapy, the best treatments are preoperative counseling. Gabapentin both pre and postoperatively, and then methadone, clonidine, bowel regimen medications, and anti-emetics.↗
▶Ep 26 · 6:02
quoteFor multimodal therapy, the best treatments are preoperative counseling. Gabapentin both pre and postoperatively, and then methadone, clonidine, bowel regimen medications, and anti-emetics.↗
▶Ep 26 · 6:02
clinicalFor multimodal pain therapy, the best treatments are preoperative counseling, gabapentin both pre and postoperatively, and then methadone, clonidine, bowel regimen medications, and anti-emetics.↗
▶Ep 26 · 6:19
clinicalIn Nebraska, where Steve Rayner practices, length of stay is under 2 days and patients are off opioids by 1 week.↗
▶Ep 26 · 7:40
clinicalComputational modeling showed that shorter flat bars have different stress points compared to traditionally U-shaped bars, with shorter bars having more pressure on the sternum and therefore being more stable.↗
Justin's statements about Shortness of Breath On Exertion4 statements
clinicalMultimodal pain control options include Tylenol, NSAIDs, precedex for gentle wake-up, dexamethasone for post-anesthetic nausea, and ketamine to avoid opioids.↗
▶Ep 1 · 5:55
clinicalNon-pharmacologic multimodal approaches include child life specialists, mindfulness resources, and supportive physical therapists.↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 2 · 6:02
clinicalFor multimodal pain therapy, the best treatments are preoperative counseling, gabapentin both pre and postoperatively, and then methadone, clonidine, bowel regimen medications, and anti-emetics.↗
▶Ep 2 · 6:02
quoteFor multimodal therapy, the best treatments are preoperative counseling. Gabapentin both pre and postoperatively, and then methadone, clonidine, bowel regimen medications, and anti-emetics.↗
Justin's statements about Spontaneous Pneumothorax1 statement
clinicalGabapentin is most commonly given once pre-op then 200-300mg three times daily for up to one week post-op; pharmacokinetics suggest starting several days before operation for peak effect.↗
Justin's statements about Spontaneous Pneumothorax1 statement
clinicalGabapentin is most commonly given once pre-op then 200-300mg three times daily for up to one week post-op; pharmacokinetics suggest starting several days before operation for peak effect.↗
Summaries Justin gave as host
· 24 summaries
Recaps of other experts' statements, not Justin's own clinical position.
Summaries Justin gave as host · Pectus Excavatum5 summaries
host summaryJustin Wagner summarizing the discussion: Dr. Ponsky's best multimodal treatments are preoperative counseling, gabapentin both pre and postoperatively, methadone, clonidine, bowel regimen medications, and anti-emetics.↗
▶Ep 25 · 6:19
host summaryJustin Wagner summarizing the discussion: At the institution where Dr. Wagner trained in Nebraska, Steve Rayner achieves length of stay under 2 days with patients off opioids by 1 week.↗
▶Ep 25 · 7:36
host summaryJustin Wagner summarizing the discussion: Physics-minded surgeons created a computational model showing that shorter flat bars have more pressure on the sternum compared to traditionally U-shaped bars, making them more stable.↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 26 · 6:19
host summaryJustin Wagner summarizing the discussion: In Nebraska, where Steve Rayner practices, length of stay is under 2 days and patients are off opioids by 1 week.↗
▶Ep 26 · 7:40
host summaryJustin Wagner summarizing the discussion: Computational modeling showed that shorter flat bars have different stress points compared to traditionally U-shaped bars, with shorter bars having more pressure on the sternum and therefore being more stable.↗
Summaries Justin gave as host · Shortness of Breath On Exertion5 summaries
host summaryJustin Wagner summarizing the discussion: Dr. Ponsky's best multimodal treatments are preoperative counseling, gabapentin both pre and postoperatively, methadone, clonidine, bowel regimen medications, and anti-emetics.↗
▶Ep 1 · 6:19
host summaryJustin Wagner summarizing the discussion: At the institution where Dr. Wagner trained in Nebraska, Steve Rayner achieves length of stay under 2 days with patients off opioids by 1 week.↗
▶Ep 1 · 7:36
host summaryJustin Wagner summarizing the discussion: Physics-minded surgeons created a computational model showing that shorter flat bars have more pressure on the sternum compared to traditionally U-shaped bars, making them more stable.↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 2 · 6:19
host summaryJustin Wagner summarizing the discussion: In Nebraska, where Steve Rayner practices, length of stay is under 2 days and patients are off opioids by 1 week.↗
▶Ep 2 · 7:40
host summaryJustin Wagner summarizing the discussion: Computational modeling showed that shorter flat bars have different stress points compared to traditionally U-shaped bars, with shorter bars having more pressure on the sternum and therefore being more stable.↗
Summaries Justin gave as host · Spontaneous Pneumothorax7 summaries
host summaryJustin Wagner summarizing the discussion: In Texas Children's study, 50% of patients still take opioids two weeks after Nuss procedure.↗
▶Ep 10 · 24:40
host summaryJustin Wagner summarizing the discussion: In past five years, hospital length of stay for Nuss procedures has been cut in half through protocol improvements.↗
▶Ep 10 · 25:20
host summaryJustin Wagner summarizing the discussion: In Nebraska protocol without epidurals, catheters, or cryo, length of stay is under two days and patients are off opioids by one week.↗
▶Ep 10 · 26:00
host summaryJustin Wagner summarizing the discussion: In Texas Children's study, urinary retention was 8% in cryo group versus 34% in non-cryo group.↗
▶Ep 10 · 26:25
host summaryJustin Wagner summarizing the discussion: Bar flippage occurs almost eight times more commonly in cryo group, and allodynia/neuropathy occurs about six times more frequently in cryo group.↗
▶Ep 10 · 37:19
host summaryJustin Wagner summarizing the discussion: Pilegaard technique uses shorter bars placed asymmetrically with right side covering two rib spaces and left side with single stabilizer, resulting in well below 1% bar flip rate.↗
▶Ep 10 · 38:10
host summaryJustin Wagner summarizing the discussion: Computational modeling shows flatter bars focus stress on sternum while bigger curved bars have parasitic forces causing unwanted horizontal and torque action at bar ends.↗
Summaries Justin gave as host · Spontaneous Pneumothorax7 summaries
host summaryJustin Wagner summarizing the discussion: In Texas Children's study, 50% of patients still take opioids two weeks after Nuss procedure.↗
▶Ep 8 · 24:40
host summaryJustin Wagner summarizing the discussion: In past five years, hospital length of stay for Nuss procedures has been cut in half through protocol improvements.↗
▶Ep 8 · 25:20
host summaryJustin Wagner summarizing the discussion: In Nebraska protocol without epidurals, catheters, or cryo, length of stay is under two days and patients are off opioids by one week.↗
▶Ep 8 · 26:00
host summaryJustin Wagner summarizing the discussion: In Texas Children's study, urinary retention was 8% in cryo group versus 34% in non-cryo group.↗
▶Ep 8 · 26:25
host summaryJustin Wagner summarizing the discussion: Bar flippage occurs almost eight times more commonly in cryo group, and allodynia/neuropathy occurs about six times more frequently in cryo group.↗
▶Ep 8 · 37:19
host summaryJustin Wagner summarizing the discussion: Pilegaard technique uses shorter bars placed asymmetrically with right side covering two rib spaces and left side with single stabilizer, resulting in well below 1% bar flip rate.↗
▶Ep 8 · 38:10
host summaryJustin Wagner summarizing the discussion: Computational modeling shows flatter bars focus stress on sternum while bigger curved bars have parasitic forces causing unwanted horizontal and torque action at bar ends.↗
