I've got a low threshold for starting with sclerotherapy because it's, it's simple, it's innocuous, and then sometimes they just need that head start, particularly in that last case with a younger kid. They just need that window of a couple of months to not have a prolapse, and then they start seeing it less frequently.
I've got a low threshold for starting with sclerotherapy because it's, it's simple, it's innocuous, and then sometimes they just need that head start, particularly in that last case with a younger kid. They just need that window of a couple of months to not have a prolapse, and then they start seeing it less frequently.
I've got a low threshold for starting with sclerotherapy because it's, it's simple, it's innocuous, and then sometimes they just need that head start, particularly in that last case with a younger kid. They just need that window of a couple of months to not have a prolapse, and then they start seeing it less frequently.
I've got a low threshold for starting with sclerotherapy because it's, it's simple, it's innocuous, and then sometimes they just need that head start, particularly in that last case with a younger kid. They just need that window of a couple of months to not have a prolapse, and then they start seeing it less frequently.
I've got a low threshold for starting with sclerotherapy because it's, it's simple, it's innocuous, and then sometimes they just need that head start, particularly in that last case with a younger kid. They just need that window of a couple of months to not have a prolapse, and then they start seeing it less frequently.
I would be remiss not to mention that we were one of the two hospitals that were in this trial and we did not see a difference in abscess rate in our cohort. So the overall group was swayed entirely by Phoenix's experience.
Update Course 2022 - TOP PUBLICATIONS IN NON- PED SURG JOURNALS - Jose Campos
▶Ep 6 · 7:04
clinicalOne participating hospital in the appendicitis antibiotic trial did not see a difference in abscess rates between the two antibiotic regimens in their cohort, while the overall study results were driven entirely by Phoenix Children's Hospital's experience.↗
▶Ep 6 · 7:04
quoteI would be remiss not to mention that we were one of the two hospitals that were in this trial and we did not see a difference in abscess rate in our cohort. So the overall group was swayed entirely by Phoenix's experience.↗
▶Ep 6 · 7:45
epidemiologicalNSQIP-P national data shows no difference in abscess rates between ceftriaxone-metronidazole and piperacillin-tazobactam across much larger patient numbers.↗
▶Ep 6 · 12:09
quoteI don't think it's binary, so I don't think it's going to be something that we're going to be able to answer as a yes or no.↗
▶Ep 6 · 12:40
clinicalIn the NEC trial, there was significant surgeon intention to treat, with most patients who received initial peritoneal drainage going to laparotomy shortly after drain placement.↗
▶Ep 6 · 12:50
quoteMost of these patients went to laparotomy shortly after drain placement, so that also kind of convolutes it.↗
▶Ep 6 · 13:42
opinionPeritoneal drainage for NEC often serves as a temporizing measure to stabilize septic patients before laparotomy rather than as definitive therapy.↗
quoteI've got a low threshold for starting with sclerotherapy because it's, it's simple, it's innocuous, and then sometimes they just need that head start, particularly in that last case with a younger kid. They just need that window of a couple of months to not have a prolapse, and then they start seeing it less frequently.↗
▶Ep 92 · 4:11
quoteI've got a low threshold for starting with sclerotherapy because it's, it's simple, it's innocuous, and then sometimes they just need that head start, particularly in that last case with a younger kid. They just need that window of a couple of months to not have a prolapse, and then they start seeing it less frequently.↗
▶Ep 92 · 4:11
opinionSclerotherapy has a low threshold for use because it is simple, innocuous, and can provide a window of a couple months without prolapse that allows younger children to see less frequent episodes.↗
▶Ep 92 · 4:11
opinionSclerotherapy has a low threshold for use because it is simple, innocuous, and can provide a window of a couple months without prolapse that allows younger children to see less frequent episodes.↗
▶Ep 92 · 4:28
clinicalDr. Sean St. Peter's sclerotherapy technique uses 5 ccs of Sotradechol injected in 4 quadrants with any remaining volume injected in between.↗
▶Ep 92 · 4:28
clinicalDr. Sean St. Peter's sclerotherapy technique uses 5 ccs of Sotradechol injected in 4 quadrants with any remaining volume injected in between.↗
Update Course 2022 - TOP PUBLICATIONS IN NON- PED SURG JOURNALS - Jose Campos
▶Ep 44 · 7:04
quoteI would be remiss not to mention that we were one of the two hospitals that were in this trial and we did not see a difference in abscess rate in our cohort. So the overall group was swayed entirely by Phoenix's experience.↗
▶Ep 44 · 7:04
clinicalOne participating hospital in the appendicitis antibiotic trial did not see a difference in abscess rates between the two antibiotic regimens in their cohort, while the overall study results were driven entirely by Phoenix Children's Hospital's experience.↗
▶Ep 44 · 7:45
epidemiologicalNSQIP-P national data shows no difference in abscess rates between ceftriaxone-metronidazole and piperacillin-tazobactam across much larger patient numbers.↗
▶Ep 44 · 12:09
quoteI don't think it's binary, so I don't think it's going to be something that we're going to be able to answer as a yes or no.↗
▶Ep 44 · 12:40
clinicalIn the NEC trial, there was significant surgeon intention to treat, with most patients who received initial peritoneal drainage going to laparotomy shortly after drain placement.↗
▶Ep 44 · 12:50
quoteMost of these patients went to laparotomy shortly after drain placement, so that also kind of convolutes it.↗
▶Ep 44 · 13:42
opinionPeritoneal drainage for NEC often serves as a temporizing measure to stabilize septic patients before laparotomy rather than as definitive therapy.↗
opinionSclerotherapy has a low threshold for use because it is simple, innocuous, and can provide a window of a couple months without prolapse that allows younger children to see less frequent episodes.↗
▶Ep 40 · 4:11
quoteI've got a low threshold for starting with sclerotherapy because it's, it's simple, it's innocuous, and then sometimes they just need that head start, particularly in that last case with a younger kid. They just need that window of a couple of months to not have a prolapse, and then they start seeing it less frequently.↗
▶Ep 40 · 4:11
quoteI've got a low threshold for starting with sclerotherapy because it's, it's simple, it's innocuous, and then sometimes they just need that head start, particularly in that last case with a younger kid. They just need that window of a couple of months to not have a prolapse, and then they start seeing it less frequently.↗
▶Ep 40 · 4:11
opinionSclerotherapy has a low threshold for use because it is simple, innocuous, and can provide a window of a couple months without prolapse that allows younger children to see less frequent episodes.↗
▶Ep 40 · 4:28
clinicalDr. Sean St. Peter's sclerotherapy technique uses 5 ccs of Sotradechol injected in 4 quadrants with any remaining volume injected in between.↗
▶Ep 40 · 4:28
clinicalDr. Sean St. Peter's sclerotherapy technique uses 5 ccs of Sotradechol injected in 4 quadrants with any remaining volume injected in between.↗
Update Course 2022 - TOP PUBLICATIONS IN NON- PED SURG JOURNALS - Jose Campos
▶Ep 60 · 7:04
quoteI would be remiss not to mention that we were one of the two hospitals that were in this trial and we did not see a difference in abscess rate in our cohort. So the overall group was swayed entirely by Phoenix's experience.↗
▶Ep 60 · 7:04
clinicalOne participating hospital in the appendicitis antibiotic trial did not see a difference in abscess rates between the two antibiotic regimens in their cohort, while the overall study results were driven entirely by Phoenix Children's Hospital's experience.↗
▶Ep 60 · 7:45
epidemiologicalNSQIP-P national data shows no difference in abscess rates between ceftriaxone-metronidazole and piperacillin-tazobactam across much larger patient numbers.↗
▶Ep 60 · 12:09
quoteI don't think it's binary, so I don't think it's going to be something that we're going to be able to answer as a yes or no.↗
▶Ep 60 · 12:40
clinicalIn the NEC trial, there was significant surgeon intention to treat, with most patients who received initial peritoneal drainage going to laparotomy shortly after drain placement.↗
▶Ep 60 · 12:50
quoteMost of these patients went to laparotomy shortly after drain placement, so that also kind of convolutes it.↗
▶Ep 60 · 13:42
opinionPeritoneal drainage for NEC often serves as a temporizing measure to stabilize septic patients before laparotomy rather than as definitive therapy.↗
clinicalIn a randomized trial of 110 patients comparing epidural to PCA, maximum pain scores did not drop off in the epidural group due to day 2-3 transition pain, whereas PCA group pain decreased over 4.5 days.↗
▶Ep 23 · 4:00
quotethis is the final nail in the coffin for the epidural, because there has to be an advantage to something that is time consuming, is an extra procedure, and imposes risk↗
▶Ep 23 · 6:20
clinicalCryotherapy technique involves freezing ribs 4 through 7 for two minutes per rib; should not go to rib 8 or below due to risk of abdominal wall paralysis.↗
▶Ep 23 · 7:10
quotewhen that patient went home on post-op day one, equipoise was lost↗
▶Ep 23 · 7:20
clinicalIn prospective observational cryoanalgesia study, six of nine patients in initial retrospective cohort went home on post-op day one.↗
▶Ep 23 · 7:55
clinicalWith cryoanalgesia, length of stay that couldn't get below four days became one day, with tight range except for occasional failures that look like traditional four-day stays.↗
▶Ep 23 · 8:30
clinicalMedian morphine equivalents with cryoanalgesia versus traditional approaches are not on the same planet in terms of magnitude of difference.↗
▶Ep 23 · 9:05
quotewhen Samuel had his, it took him two weeks before he could put his own shirt on. And he goes, this morning, Jacob took a shower, put his own shirt on↗
▶Ep 23 · 17:30
quoteif the leap is so big, that how can you then ethically randomize when you already start with such a radical difference in outcome?↗
▶Ep 23 · 18:20
quoteI'm impressed with how many kids have normal sensation, even in the early post-op phase, two, three weeks that they can feel their anterior chest↗
▶Ep 23 · 18:20
clinicalMany patients have normal anterior chest sensation even in early post-op phase (two to three weeks) after cryoanalgesia, suggesting nerve stunning rather than complete death.↗
▶Ep 23 · 19:00
epidemiologicalAdult experience using cryotherapy with thoracotomies goes back 20 years without high enough incidence of complications to warrant backing away from the treatment advantage.↗
▶Ep 23 · 29:24
clinicalActivity restrictions beyond two weeks post-Nuss can be liberalized to anything the patient can handle, including bull riding, boxing, football, and hockey.↗
▶Ep 23 · 30:50
opinionWhen bars flip, it is always technical - related to bar sitting in funky inner space, bad spot, not wrapped tight enough, or not secured well - not related to patient activity or pain modality.↗
quoteYou go back to the OR and you'll find a reason why it flipped and it's not the patient↗
▶Ep 23 · 39:16
epidemiologicalIn updated series of 554 patients, bar rotation rate was 0.7%, with most occurring within first few years of surgeon experience.↗
▶Ep 23 · 43:20
clinicalSub-xiphoid dissection technique allows palpation-guided bar passage and has resulted in 0% incidence of pericarditis.↗
▶Ep 23 · 59:24
clinicalIn 15-patient magnetic repair trial, magnets were safe to place in children's chests and well-tolerated, but results were not as effective as hoped; appears most effective in young children with flexible chests.↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 25 · 1:07
clinicalDr. Saint Peter's institution completed a randomized trial of 110 patients comparing epidural to PCA for pectus excavatum pain control, and epidurals did not show superior performance.↗
▶Ep 25 · 1:07
quoteWe, of course, struggled with post-operative pain management as everybody did, and we had completed a randomized trial, 110 patients to epidural and PCA.↗
▶Ep 25 · 1:07
clinicalDr. Saint Peter's institution completed a randomized trial of 110 patients comparing epidural to PCA for pectus excavatum pain control, and epidurals did not show superior performance.↗
▶Ep 25 · 1:07
quoteWe, of course, struggled with post-operative pain management as everybody did, and we had completed a randomized trial, 110 patients to epidural and PCA.↗
▶Ep 25 · 1:32
clinicalIn Dr. Saint Peter's cryoanalgesia trial with approximately 30 patients per group, equipoise was lost when patients went home on post-op day one.↗
▶Ep 25 · 1:32
clinicalIn Dr. Saint Peter's cryoanalgesia trial with approximately 30 patients per group, equipoise was lost when patients went home on post-op day one.↗
▶Ep 25 · 1:33
quoteWe had about 30 patients in each group when we tried the cryotherapy and when that patient went home on post-op day one, equipoise was lost.↗
▶Ep 25 · 1:33
quoteWe had about 30 patients in each group when we tried the cryotherapy and when that patient went home on post-op day one, equipoise was lost.↗
▶Ep 25 · 1:42
quoteOnce you, once you see it, it's, it's sort of a different game.↗
▶Ep 25 · 1:42
quoteOnce you, once you see it, it's, it's sort of a different game.↗
▶Ep 25 · 2:10
clinicalThe cryoanalgesia technique involves counting down to the 4th rib and freezing underneath it for 2 minutes per rib, treating ribs 4 through 7.↗
▶Ep 25 · 2:10
clinicalThe cryoanalgesia technique involves counting down to the 4th rib and freezing underneath it for 2 minutes per rib, treating ribs 4 through 7.↗
▶Ep 25 · 2:19
quoteYou literally just count down to the 4th rib and then freeze underneath it.↗
▶Ep 25 · 2:19
quoteYou literally just count down to the 4th rib and then freeze underneath it.↗
clinicalCryoanalgesia should not be performed on rib 8 or below because it can cause abdominal wall paralysis.↗
▶Ep 25 · 2:29
quoteYou're not supposed to go 8 or below because you can get some abdominal wall paralysis.↗
▶Ep 25 · 2:29
clinicalCryoanalgesia should not be performed on rib 8 or below because it can cause abdominal wall paralysis.↗
▶Ep 25 · 2:29
quoteYou're not supposed to go 8 or below because you can get some abdominal wall paralysis.↗
▶Ep 25 · 2:37
quoteWhat we saw there is the length of stay where we just couldn't get below 4 days, all of a sudden became 1.↗
▶Ep 25 · 2:37
clinicalWith cryoanalgesia, hospital length of stay decreased from 4 days to 1 day at Dr. Saint Peter's institution.↗
▶Ep 25 · 2:37
clinicalWith cryoanalgesia, hospital length of stay decreased from 4 days to 1 day at Dr. Saint Peter's institution.↗
▶Ep 25 · 2:37
quoteWhat we saw there is the length of stay where we just couldn't get below 4 days, all of a sudden became 1.↗
▶Ep 25 · 2:46
clinicalCryoanalgesia dramatically reduced median morphine equivalents compared to previous pain management approaches.↗
▶Ep 25 · 2:46
clinicalCryoanalgesia dramatically reduced median morphine equivalents compared to previous pain management approaches.↗
▶Ep 25 · 6:39
clinicalBar flippage typically occurs early and is caused by the bar sitting in a funky interspace, sitting in a bad spot, not being wrapped tight enough, or not being secured well.↗
▶Ep 25 · 6:39
quoteSo typically if bars are going to flip, they're going to flip early and it's going to be because they were sitting in a in a funky inner space.↗
▶Ep 25 · 6:39
clinicalBar flippage typically occurs early and is caused by the bar sitting in a funky interspace, sitting in a bad spot, not being wrapped tight enough, or not being secured well.↗
▶Ep 25 · 6:39
quoteSo typically if bars are going to flip, they're going to flip early and it's going to be because they were sitting in a in a funky inner space.↗
▶Ep 25 · 6:54
quoteThat bar's got to sit in a comfortable position before you start to secure it or it's probably not going to stay there.↗
▶Ep 25 · 6:54
clinicalThe bar must sit in a comfortable position before securing or it will not stay in place; securing alone does not prevent bar flippage.↗
▶Ep 25 · 6:54
quoteThat bar's got to sit in a comfortable position before you start to secure it or it's probably not going to stay there.↗
▶Ep 25 · 6:54
clinicalThe bar must sit in a comfortable position before securing or it will not stay in place; securing alone does not prevent bar flippage.↗
▶Ep 25 · 8:50
clinicalDr. Saint Peter continues to use subxiphoid incision along with thoracoscopy, sternal elevator, or vacuum bell in the operating room as safety techniques to avoid cardiac injury.↗
▶Ep 25 · 8:50
clinicalDr. Saint Peter continues to use subxiphoid incision along with thoracoscopy, sternal elevator, or vacuum bell in the operating room as safety techniques to avoid cardiac injury.↗
▶Ep 25 · 9:05
host_summaryDr. Holcomb's principle is that whatever technique helps avoid injuring the heart is the technique that should be used.↗
▶Ep 25 · 9:05
opinionDr. Holcomb's principle is that whatever technique helps avoid injuring the heart is the technique that should be used.↗
▶Ep 25 · 9:05
quoteThe idea is to Uh, not injure the heart. So whatever technique helps you do that, I, I think is the technique you ought to use.↗
▶Ep 25 · 9:05
quoteThe idea is to Uh, not injure the heart. So whatever technique helps you do that, I, I think is the technique you ought to use.↗
▶Ep 25 · 9:54
clinicalOne surgeon learned left to right but switched to right to left and found it easier, particularly when using external elevator and thoracoscopy for safety.↗
▶Ep 25 · 9:54
clinicalOne surgeon learned left to right but switched to right to left and found it easier, particularly when using external elevator and thoracoscopy for safety.↗
▶Ep 25 · 10:12
opinionDirection of bar passage is likely surgeon preference and does not make much difference as long as the substernal space is well dissected and everything is clear.↗
▶Ep 25 · 10:12
opinionDirection of bar passage is likely surgeon preference and does not make much difference as long as the substernal space is well dissected and everything is clear.↗
quoteI've got a low threshold for starting with sclerotherapy because it's, it's simple, it's innocuous, and then sometimes they just need that head start, particularly in that last case with a younger kid. They just need that window of a couple of months to not have a prolapse, and then they start seeing it less frequently.↗
▶Ep 2 · 4:11
opinionSclerotherapy has a low threshold for use because it is simple, innocuous, and can provide a window of a couple months without prolapse that allows younger children to see less frequent episodes.↗
▶Ep 2 · 4:28
clinicalDr. Sean St. Peter's sclerotherapy technique uses 5 ccs of Sotradechol injected in 4 quadrants with any remaining volume injected in between.↗
quoteWe, of course, struggled with post-operative pain management as everybody did, and we had completed a randomized trial, 110 patients to epidural and PCA.↗
▶Ep 1 · 1:07
clinicalDr. Saint Peter's institution completed a randomized trial of 110 patients comparing epidural to PCA for pectus excavatum pain control, and epidurals did not show superior performance.↗
▶Ep 1 · 1:32
clinicalIn Dr. Saint Peter's cryoanalgesia trial with approximately 30 patients per group, equipoise was lost when patients went home on post-op day one.↗
▶Ep 1 · 1:33
quoteWe had about 30 patients in each group when we tried the cryotherapy and when that patient went home on post-op day one, equipoise was lost.↗
▶Ep 1 · 1:42
quoteOnce you, once you see it, it's, it's sort of a different game.↗
▶Ep 1 · 2:10
clinicalThe cryoanalgesia technique involves counting down to the 4th rib and freezing underneath it for 2 minutes per rib, treating ribs 4 through 7.↗
▶Ep 1 · 2:19
quoteYou literally just count down to the 4th rib and then freeze underneath it.↗
clinicalCryoanalgesia should not be performed on rib 8 or below because it can cause abdominal wall paralysis.↗
▶Ep 1 · 2:29
quoteYou're not supposed to go 8 or below because you can get some abdominal wall paralysis.↗
▶Ep 1 · 2:37
clinicalWith cryoanalgesia, hospital length of stay decreased from 4 days to 1 day at Dr. Saint Peter's institution.↗
▶Ep 1 · 2:37
quoteWhat we saw there is the length of stay where we just couldn't get below 4 days, all of a sudden became 1.↗
▶Ep 1 · 2:46
clinicalCryoanalgesia dramatically reduced median morphine equivalents compared to previous pain management approaches.↗
▶Ep 1 · 6:39
quoteSo typically if bars are going to flip, they're going to flip early and it's going to be because they were sitting in a in a funky inner space.↗
▶Ep 1 · 6:39
clinicalBar flippage typically occurs early and is caused by the bar sitting in a funky interspace, sitting in a bad spot, not being wrapped tight enough, or not being secured well.↗
▶Ep 1 · 6:54
clinicalThe bar must sit in a comfortable position before securing or it will not stay in place; securing alone does not prevent bar flippage.↗
▶Ep 1 · 6:54
quoteThat bar's got to sit in a comfortable position before you start to secure it or it's probably not going to stay there.↗
▶Ep 1 · 8:50
clinicalDr. Saint Peter continues to use subxiphoid incision along with thoracoscopy, sternal elevator, or vacuum bell in the operating room as safety techniques to avoid cardiac injury.↗
▶Ep 1 · 9:05
opinionDr. Holcomb's principle is that whatever technique helps avoid injuring the heart is the technique that should be used.↗
▶Ep 1 · 9:05
quoteThe idea is to Uh, not injure the heart. So whatever technique helps you do that, I, I think is the technique you ought to use.↗
▶Ep 1 · 9:54
clinicalOne surgeon learned left to right but switched to right to left and found it easier, particularly when using external elevator and thoracoscopy for safety.↗
▶Ep 1 · 10:12
opinionDirection of bar passage is likely surgeon preference and does not make much difference as long as the substernal space is well dissected and everything is clear.↗
