v3 Chapter 2626： All-around beyond

"Boss, does Lao He feel that something is missing?" Su Yun asked with a smile while standing in the operating room while preparing the instruments.

"Well, get used to it." Zheng Ren nodded.

But you ca n’t take the entire medical team with you every time you go. It ’s unreasonable.

"You blew Laohe in Yangcheng. I heard him say that there is an anesthesia academic conference this weekend. Director Qiu of Yangcheng must come to see Laohe." Su Yundao.

"It's not blowing, the level of Lao He must be very high." Zheng Ren said, "Otherwise, the separation operation of the conjoined heart could not be performed."

"Not scolded by you yet."

"When did I scold Lao He?"

"Exaggerated art, don't be so good." Su Yun commissioned the operating table and asked, "The angle of the semi-recumbent position can only be this level, you see."

Zheng Ren nodded. "As long as the patient can accept it."

Generally speaking, the operation requires a supine position, but the patient in front of him cannot lie supine because of a blocked airway and a small amount of inhaled oxygen.

This is also a common feature of many patients with advanced lung cancer, also known as sitting breath.

It is impossible to lie down for surgery, so the surgeon can barely deal with it, change the surgical position, and choose a semi-recumbent position.

Soon the patient arrived and was carried to the operating table, in a semi-recumbent position and inhaled with a mask, oxygen at 10 l / min.

Seeing that the patient's blood oxygen saturation was good, Zheng Ren had an operation and brushed his hands with Su Yun to prepare for the operation.

The right femoral vein was percutaneously inserted into a 28F venous cannula for drainage, and the left femoral artery was percutaneously inserted into a 20F femoral artery for perfusion.

Then quietly waited for 30 minutes to start VA-ECMO.

After ECMO started, Zheng Ren made a gesture.

But he immediately realized that this was not in the country, and Lao He was not with him.

Su Yun noticed, laughed, and said, "Boss, you just forget when you've finished speaking."

"Well, I'm really used to it." Zheng Ren said, and began to communicate with Botta's anesthetist.

The patient was sedated with intravenous propofol-based anaesthesia, and the patient's position was changed to the supine position. Patients who were unable to lie supine under the action of ECMO did not experience any abnormal response.

Blood oxygen saturation was good, vital signs were smooth, and everything went smoothly.

Only then did Su Yun breathe a sigh of relief, and the doctor Ni standing in the operating room was completely lost.

The idea is simple, why didn't you think of it yourself? In the minds of the two, an idea emerged at the same time.

"Su Yun, you are staring at ECMO, and I have surgery with rich children," Zheng Rendao said.

"Well, boss." Professor Rudolph Wagner responded cheerfully.

Su Yun didn't say much, but kept staring at the machine. Pre-filling of the circulatory system-100 ml of fresh plasma, 400 ml of Ringer's solution, 2 mg / kg of heparin, and monitoring of MAP and SaO2 during flow The blood flow rate was 2.5 L / min, keeping SaO2 above 90%.

Everything was perfect, he made a gesture to signal that Zheng Ren could start to operate.

Zheng Ren was also satisfied with the data displayed on the ECG monitoring. The patient inserted a fiber bronchoscope through the nose.

Zheng Ren saw on the screen the extraluminal stenosis of the middle trachea accompanied by new organisms in the lumen, and the lumen was basically blocked. He began to choose a guide wire and slowly fed in along the patient's airway.

As previously predicted, the airway is different from the esophagus, as long as the patient is alive, there is no possibility that the main airway will be completely occluded.

Although the airway was twisted, Zheng Ren easily pushed the guide wire into it.

"Boss, step on the line or use a bronchoscope?" Su Yun asked.

"Step on the line." Zheng Ren chose the most secure way.

Looking at the patient's condition, simply observing the stent with a bronchoscope is also possible, but not as intuitive as DSA Robots see it.

An 18mm × 40mm nickel-iron alloy tracheal stent is delivered to the position, and then the stent is released and the stent implant is pulled out. Zheng Ren began to attract **** secretions and adjusted the position of the stent with biopsy forceps. Under the DSA machine, it was seen that the tracheal stent had been opened and the airway was unobstructed.

"Can stop ECMO." Zheng Ren said.

Su Yun then began to communicate with the anesthesiologist on this side, neutralizing with protamine, and stopping the operation of ECMO.

The real running time of ECMO is only 12′26 seconds, and the operation is completed simply.

An operation that was determined by Botta to be inoperable was completed in such a calm manner.

Zheng Ren did not rush to send the patient back, and observed in the operating room for a full 30 minutes. The observation time was even longer than the formal operation.

To such a degree of caution, Su Yun is also very convinced.

"Dr. Zheng, your thinking is really good." Dr. Ni went into the operating room and communicated with Zheng Ren. Dr. Zheng's surgical skills were not visible in this operation, which was mainly an alternative use of ECMO, which opened up Nico's thinking.

"Well, the operation process is still a bit slow, and there is a problem with cooperation." Zheng Ren's eyes continued to watch back and forth between the ECG monitor and the patient.

"The cooperation is already very good!" Dr. Ni said in surprise. Is this Dr. Zheng really? The longest time for the entire operation was delayed during his observation of the patient after surgery.

"The turn of ECMO, if my anaesthetist comes, can be controlled in about 6 minutes." Zheng Ren did not see Dr. Ni, but just chatted casually.

6 minutes ...

This number surprised Dr. Ni.

Only a trained medical team can control the start-up time of ECMO within 15 minutes, compared to 30 minutes before Dr. Zheng's operation.

This time is not long, it is just normal.

But 6 minutes, is this really good?

"My God ..." Dr. Ni was originally surprised with Dr. Zheng's surgery and thoughts, but did not expect that he was talking to himself about the launch time of ECMO.

Is this Dr. Zheng telling himself ~ www.novelhall.com ~ that his medical team surpassed himself and Bota Private Hospital in all aspects.

Su Yun glanced at his boss and smiled, "Boss, would you be so proud of him, would he be proud?"

"To be honest." Zheng Rendao, "It's fine to recover, ready to return to the ward."

In the system operating room, the assistant who cooperates with the operation should use Laohe as a template. It really took only 6 minutes during the ECMO warm-up phase. Zheng Ren was just telling the truth, without any exaggeration.

"Dr. Zheng, is there anything to be aware of after surgery?" Dr. Ni asked.

"Recheck the CT after 1 day to see if the tracheal lumen is unobstructed and the position of the stent. After 2 days, check the bronchoscope to see if the middle tracheal tracheal stent has been fully expanded." Zheng Rendao, "There is nothing else, the patient breathes The difficult state has been resolved, the rest is a few days of rest, and the body can recover for the next step of treatment. "

After speaking, Zheng Ren left the operating table, turned around, took off the sterile gloves, and threw it into the bucket of medical waste.