Update Course Rewind: Pectus Excavatum 2021
With Dr. Steven Lee & Dr. Sean Saint Peter & Dr. Victor Garcia & Dr. Steven Rothenberg · hosted by Dr. Cecilia Gena & Dr. Ellen Ancisco · StayCurrentMD
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Video
Update Course Rewind: Pectus Excavatum 2021
Dr. Todd Ponsky · 11 min · Published Aug 2022
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Update Course Rewind: Pectus Excavatum 2021
Dr. Lee Ponsky · 11 min · Published Aug 2022
Podcast
Update Course Rewind: Pectus Excavatum 2021
Dr. Lee Ponsky · 11 min · Published Aug 2022
Podcast
Update Course Rewind: Pectus Excavatum 2021
Dr. Lee Ponsky · 11 min · Published Aug 2022
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61 min · Published May 2022
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Cryoablation in 350 Nuss procedures
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What the experts said
A randomized trial of 110 patients comparing epidural and PCA for pectus excavatum pain control showed epidurals did not provide superior pain relief
After implementing cryoanalgesia, patients went home on post-operative day one, leading to loss of equipoise in the trial comparing it to epidural/PCA
Cryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain
Cryoanalgesia technique involves freezing underneath ribs 4 through 7 for 2 minutes per rib
Cryoanalgesia should not be performed on rib 8 or below due to risk of abdominal wall paralysis
With cryoanalgesia, length of stay decreased from 4 days to 1 day
Cryoanalgesia dramatically reduced median morphine equivalents compared to previous pain management approaches
There are no long-term studies on cryoanalgesia outcomes
Medical devices and implants are not required to undergo clinical trials before market introduction, unlike drugs
Erector spinal catheters are placed by the pain team with ultrasound guidance and are juxtaposed to but not in the vertebral space
With erector spinal catheters, hospital stay is 2 days, catheters stay in for 5 days total, and are removed by family on day 3 at home
Erector spinal catheters reduced opioid requirements both in hospital and after discharge
Cryoanalgesia changed patient condition at discharge - not just earlier discharge but better functional status at time of discharge
Multimodal pain therapy should include preoperative counseling, gabapentin pre and postoperatively, methadone, clonidine, bowel regimen medications, and anti-emetics
With multimodal pain regimen at Nebraska, length of stay is under 2 days and patients are off opioids by 1 week
Bar flips typically occur early and are due to the bar sitting in a bad position, not being wrapped tight enough, or not being secured well
Bar flippage is completely a surgical technique issue
Computational modeling shows shorter flat bars have more pressure on the sternum and are therefore more stable than traditional U-shaped bars
Sternal elevator use allows less tissue damage and better repair in deep stiff pectus cases
Sternal elevator allows entry and exit at the same interspace
Passing the bar from left chest to right chest is safer because the opposite direction points the instrument directly at the ventricle