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
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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
Cryoanalgesia uses cold temperatures to cause a conduction block, interrupting pain impulses to the brain.
host_summaryCecilia Gigena1:57 ↗
Cryoanalgesia technique involves counting down to the 4th rib and freezing underneath it for 2 minutes per rib, treating ribs 4 through 7.
clinical2:19 ↗
Cryoanalgesia should not be performed on rib 8 or below because it can cause abdominal wall paralysis.
clinical2:29 ↗
With cryoanalgesia, length of stay decreased from 4 days to 1 day.
clinical2:37 ↗
Cryoanalgesia dramatically reduced median morphine equivalents compared to previous pain management methods.
clinical2:46 ↗
There are no long-term studies on cryoanalgesia outcomes.
clinicalVictor Garcia3:04 ↗
Medical devices and implants are not required to undergo clinical trials before being introduced to market, unlike drugs.
guidelineVictor Garcia3:24 ↗
The FDA requires clinical trials with long-term results for medications before approval, but not for medical devices and techniques.
host_summaryCecilia Gigena3:36 ↗
Erector spinal catheters are placed by the pain team with ultrasound guidance, positioned juxtaposed to but not in the vertebral space.
clinicalVictor Garcia4:09 ↗
With erector spinal catheters, hospital stay is 2 days, catheters stay in for 5 days, and are pulled out by the family on day 3 while the patient is at home.
clinicalVictor Garcia4:19 ↗
Erector spinal catheters reduced opioid requirements both in the hospital and outside the hospital.
clinicalVictor Garcia4:33 ↗
With erector spinal catheters, hospital stays are 2 days, which is much less than the 4-5 days seen with epidurals.
clinicalVictor Garcia4:45 ↗
With cryoanalgesia, it is not just when patients go home but how they feel when they go home that has changed dramatically.
opinionSteven Rothenberg5:08 ↗
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.
clinicalJustin Wagner6:02 ↗
In Nebraska, where Steve Rayner practices, length of stay is under 2 days and patients are off opioids by 1 week.
host_summaryJustin Wagner6:19 ↗
If bars are going to flip, they flip early because they were sitting in a funky inner space, in a bad spot, the bar wasn't wrapped tight enough, or it wasn't secured well.
clinical6:39 ↗
The bar must sit in a comfortable position before securing it or it probably will not stay there.
clinical6:54 ↗
Bar flippage is completely a surgical issue.
opinionSteven Rothenberg6:59 ↗
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.
host_summaryJustin Wagner7:40 ↗
A sternal elevator is used in about 10% of cases, primarily in really deep stiff pectuses where it allows less tissue damage and a better repair.
clinicalSteven Rothenberg8:19 ↗
In the average younger patient, thoracoscopy provides adequate visualization without needing a sternal elevator.
clinicalSteven Rothenberg8:22 ↗
Using a sternal elevator in every case eliminates guesswork and allows entry and exit at the same interspace.
clinicalVictor Garcia8:35 ↗
Techniques to avoid cardiac injury include thoracoscopy, sternal elevator, vacuum bell in the operating room, or subxiphoid incision.
clinical8:59 ↗
Passing the bar from left chest to right chest is preferred by some because going right to left means the instrument points directly at the ventricle.
clinical9:31 ↗
Bar passage direction (left-to-right versus right-to-left) is surgeon preference and probably does not make much difference as long as the substernal space is well dissected and everything is clear.
opinion10:12 ↗
Dr. 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.
clinicalShawn St. Peter1:07 ↗
In Dr. Saint Peter's cryoanalgesia trial with approximately 30 patients per group, equipoise was lost when patients went home on post-op day one.
clinicalShawn St. Peter1:32 ↗
Cryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain.
host_summaryCecilia Gigena1:57 ↗
The cryoanalgesia technique involves counting down to the 4th rib and freezing underneath it for 2 minutes per rib, treating ribs 4 through 7.
clinicalShawn St. Peter2:10 ↗
Cryoanalgesia should not be performed on rib 8 or below because it can cause abdominal wall paralysis.
clinicalShawn St. Peter2:29 ↗
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