Update Course Rewind: 2024 Top Ten Key Takeaways
With Dr. Ramy Shaaban · Ramy Shaaban
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Cross-training occurs at Cincinnati Children's with interventional radiologists teaching pediatric surgery fellows ultrasound guidance for vascular access
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
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
ChatGPT can screen thousands of articles in systematic review by analyzing Excel sheets and providing explanations for inclusion/exclusion decisions
Jenny AI provides suggestions for research writing, cites supporting papers, and formats citations according to preferred style
Cryoanalgesia temporarily freezes nerves to alleviate pain during chest wall surgery
Double lumen endotracheal tube deflates the lung on the side of cryoablation and surgeon uses thoracoscope to guide cryoprobe through axillary incisions
Cryoanalgesia targets nerves from T3 to T8 with two-minute freeze cycles
Subpleural injection with quarter percent marcaine with epinephrine works immediately as opposed to eight to ten hour delay with cryo nerve block
Double lumen endotracheal tube helps reduce risk of pneumothorax during cryoanalgesia
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
If you had good prenatal counseling with parents, you should pursue ECMO for every unilateral isolated CDH
With bivalirudin anticoagulation, you can operate after eight hours of putting patient on ECMO as long as levels are stable
Early repair while on ECMO is safe with optimal window between eight to 24 hours
CO2 laser emits infrared light in spectrum of 920 to 1,400 nanometers which is well absorbed by water
In 56 circumcision cases using CO2 laser with sleeve technique and cyanoacrylate adhesive, complication rate was only three percent
Autofluorescence has shown to reduce rates of hyperparathyroidism and hypocalcemia following thyroidectomy in randomized control trial from France
Parathyroids naturally autofluorescence at specific wavelength without injection
Fluobeam system showed hypocalcemia rates about half with use versus not using it
Surgery-first pathway reduces resource utilization including MRCP in pediatric biliary stone cases
ERCP causes pancreatitis 10% of the time regardless of operator skill
With surgery-first mindset, stone clearance rate reflected by negative intraoperative cholangiogram was 86%
MMP7 was identified about 10 years ago as diagnostic biomarker for biliary atresia
Data from Midwest study shows every 10-day delay in biliary atresia treatment worsens outcomes by 20%
MMP7 is now validated biomarker for biliary atresia with good sensitivity, though cutoffs vary as assay is still evolving
Cincinnati Children's commitment is to perform Kasai procedure within seven days of biliary atresia diagnosis
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
REBOA seems to take longer than opening abdomen or chest if just needing to cross-clamp aorta
Most surgeons favor laparotomy over REBOA for quickly treating shock in controlled environment
Patients presenting with wounds as initial presentation for pilonidal tend to not always get to finish line fully healed with minimally invasive approach
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
If not pushing hair removal and meticulous hygiene, will probably end up operating on some pilonidal patients that might not need operation