Spontaneous Pneumothorax
Everything in the library about spontaneous pneumothorax — 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
1 item
Update Course Rewind 2021 - Updates in Pectus
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In this session from the 2021 Update Course, Dr. Steven Lee, MD presents updates in the perioperative care of patient with pectus excavatum including perioperative pain control, Nuss bar length measurements, right vs left approach, and much
video61:14 · May 2022
Case-Based Learning
2 items
Supine Positioning for Bilateral VATS: Pediatric Surgery Difficult...
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During the Pediatric Surgery Tricks of the Trade and Difficult Cases: Innovative Solutions to Common Problems Course in 2013, Dr. Nick Bruns presents a clinical case of supine positioning for bilateral video-assisted thorascopic surgery (VA
video15:50 · Sep 2018
Tricks - Supine Positioning For Bilateral VATS
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Dr. Nick Bruns gives a presentation of a clinical case of supine positioning for bilateral video-assisted thorascopic surgery (VATS). Dr. Brun's demonstration includes topics of open thoracotomy versus VATS, pleurodesis, blood patch techniq
video17:04 · Nov 2018
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Update Course Rewind 2021 - Updates in Pectus
In 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.
clinicalShawn St. Peter3:27 ↗
Cryotherapy 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.
clinicalShawn St. Peter6:20 ↗
In prospective observational cryoanalgesia study, six of nine patients in initial retrospective cohort went home on post-op day one.
clinicalShawn St. Peter7:20 ↗
With 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.
clinicalShawn St. Peter7:55 ↗
Median morphine equivalents with cryoanalgesia versus traditional approaches are not on the same planet in terms of magnitude of difference.
clinicalShawn St. Peter8:30 ↗
Medical devices and implants are not required to undergo clinical trials before market introduction, unlike drugs.
guidelineVictor Garcia10:40 ↗
Cryotherapy devices received FDA approval via 510(k) predicate pathway based on similarity to devices from 1976, not based on clinical trials.
guidelineVictor Garcia14:10 ↗
With erector spinae catheters, hospital stay is two days with reduced opioid requirements both in-hospital and post-discharge.
clinicalVictor Garcia28:20 ↗
When 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.
opinionShawn St. Peter30:50 ↗
Activity restrictions beyond two weeks post-Nuss can be liberalized to anything the patient can handle, including bull riding, boxing, football, and hockey.
clinicalShawn St. Peter29:24 ↗
In Texas Children's study, 50% of patients still take opioids two weeks after Nuss procedure.
host_summaryJustin Wagner24:10 ↗
In past five years, hospital length of stay for Nuss procedures has been cut in half through protocol improvements.
host_summaryJustin Wagner24:40 ↗
In Nebraska protocol without epidurals, catheters, or cryo, length of stay is under two days and patients are off opioids by one week.
host_summaryJustin Wagner25:20 ↗
In Texas Children's study, urinary retention was 8% in cryo group versus 34% in non-cryo group.
host_summaryJustin Wagner26:00 ↗
Bar flippage occurs almost eight times more commonly in cryo group, and allodynia/neuropathy occurs about six times more frequently in cryo group.
host_summaryJustin Wagner26:25 ↗
In randomized epidural trial, epidural could either not be placed or was removed after one day in approximately 25% of patients.
host_summaryWhit26:55 ↗
Adult experience using cryotherapy with thoracotomies goes back 20 years without high enough incidence of complications to warrant backing away from the treatment advantage.
epidemiologicalShawn St. Peter19:00 ↗
With cryoanalgesia, 70% of patients go home on post-op day one without narcotics.
clinicalSteven Rothenberg34:00 ↗
Sternal elevator is used in about 10% of cases, primarily in older males with deep, stiff pectus where flexibility is limited.
clinicalSteven Rothenberg45:50 ↗
In updated series of 554 patients, bar rotation rate was 0.7%, with most occurring within first few years of surgeon experience.
epidemiologicalShawn St. Peter39:16 ↗
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.
host_summaryJustin Wagner37:19 ↗
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.
host_summaryJustin Wagner38:10 ↗
Sub-xiphoid dissection technique allows palpation-guided bar passage and has resulted in 0% incidence of pericarditis.
clinicalShawn St. Peter43:20 ↗
Many 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.
clinicalShawn St. Peter18:20 ↗
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.
clinicalJustin Wagner22:40 ↗
When passing bar from left chest to right chest, the angle avoids pointing directly at the ventricle compared to right-to-left passage.
clinical41:20 ↗
In 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.
clinicalShawn St. Peter59:24 ↗
Supine Positioning for Bilateral VATS: Pediatric Surgery Difficult...
Lateral decubitus positioning was adopted from the transition from open thoracotomy to VATS but may add unnecessary morbidity including brachial plexus injury and decubitus ulcers.
host_summary0:03 ↗
The presented case involved a 17-year-old male with asthma presenting with shortness of breath and chest tightness when running, found to have bilateral apical blebs and a large right spontaneous pneumothorax treated with chest tube, followed by a small left spontaneous pneumothorax that resolved with observation.
host_summary0:30 ↗
Bilateral VATS with bilateral apical bleb resections and mechanical pleurodesis was performed in supine position with single sterile preparation, reducing operative time.
host_summary1:30 ↗
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