Chapter 2626

"Boss, don't you think Lao he is missing something?" Su Yun stood in the operating room and asked with a smile while preparing the instrument.

"Well, I'm used to it." Zheng Ren nodded.

But you can't take all the members of the medical team every time you travel. No, that's unreasonable.

"You played Lao he in Yangcheng. I heard him say that there will be an anesthesia academic meeting this weekend. Director Qiu of Yangcheng must come to see Lao he." Su yundao.

"It's not blowing. Lao he's level must be very high." Zheng Ren said, "otherwise, the separation operation of the conjoined heart baby could not be done."

"You haven't scolded me yet."

"When did I scold Lao he?"

"Artistic exaggeration, don't be so serious." Su Yun adjusted the operating table and asked, "the angle of the semi recumbent position can only be this degree. Do you think it's ok?"

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

Generally speaking, the operation should be in the supine position, but the patient in front of him can't lie flat because of his airway blockage and less oxygen inhalation, so he has problems with cardiopulmonary function.

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

Lying down for surgery is impossible, so the operator can only manage reluctantly, change the surgical position and choose the semi recumbent position.

Soon, the patient was sent to the operating table and was carried to the semi recumbent position and inhaled oxygen with a mask. The oxygen was 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 percutaneous inserted into 28F venous intubation for drainage, and the left femoral artery was percutaneous inserted into 20f femoral artery intubation for perfusion.

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

After ECMO started, Zheng Ren made a gesture.

But he immediately realized that this was not in China, and Lao he was not with him.

Su Yun noticed, laughed and said, "boss, you forgot as soon as you finished."

"Well, I'm really used to it." Zheng Ren finished and began to communicate with bota's anesthesiologist.

Intravenous propofol was given for basic anesthesia and sedation, and then the patient's body position was changed to supine position. Patients who could not lie on their back did not have any abnormal reaction when they entered the state of lying on their back under the action of ECMO.

Blood oxygen saturation is good, vital signs are stable, and everything is going well.

Until then, Su Yun took a breath, and Dr. Nicole standing in the operation room was disappointed.

The idea is very simple. Why didn't you think of it? In their minds, an idea emerged at the same time.

"Su Yun, you stare at ECMO. Fuguier and I have an operation." Zheng Rendao.

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

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

Everything was perfect. He made a gesture to show Zheng Ren that he could start the operation.

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

Through the screen, Zheng Ren saw the external pressure stenosis of the middle tracheal lumen with new organisms in the lumen, and the lumen was basically blocked. He began to select the guide wire and slowly sent it 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 of complete occlusion of the main airway.

Although the airway passage was distorted, Zheng Ren easily lowered the guide wire.

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

"Tread the line." Zheng Ren still chose the safest way.

It is also possible to simply observe the stent with tracheoscope to see the patient's condition, but it is not as intuitive as DSA robot man.

18mm × The 40mm Ni Fe alloy tracheal stent was sent to the position, then the stent was released and the stent implant was pulled out. Zheng Ren began to attract blood secretions and adjusted the position of the stent with biopsy forceps. Under the DSA machine, it can be seen that the tracheal stent has been opened and the airway has been unblocked.

"You can stop ECMO." Zheng Rendao.

Su Yun then began to communicate with the anesthesiologist on this side, neutralized it with protamine and stopped the operation of ECMO.

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

An operation that was judged by bota to be inoperable was finished so quietly.

Zheng Ren was not in a hurry to send the patient back. He observed in the operating room for a full 30 minutes, which was even longer than the formal operation.

Su Yun was convinced that he was so cautious.

"Dr. Zheng, your thinking is really powerful." Dr. Nicole walked into the operating room and communicated with Zheng Ren. This operation does not show Dr. Zheng's surgical skills. It is mainly an alternative use of ECMO, which opens Nicole's mind.

"Well, the operation process is still a little slow. There is a problem with the cooperation." Zheng Ren's eyes kept observing back and forth between ECG monitoring and patients.

"The cooperation has been very good!" Dr. Niko said in surprise, is Dr. Zheng serious? The longest time of the whole operation was in the process of observing patients after operation.

"ECMO's turnaround can be controlled in about 6 minutes if my anesthesiologist comes." Zheng Ren didn't see Dr. Niko either, just chatting casually.

6 minutes

This figure surprised Dr. Nicole.

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

This time is not long. It's just normal.

But six minutes, is that really good?

"My God..." Dr. Niko was surprised by Dr. Zheng's operation and ideas, but he didn't expect that he was talking to himself about the start-up time of ECMO.

Is Dr. Zheng telling himself that his medical team has surpassed himself and bota private hospital in all aspects.

Su Yun glanced at his boss and said with a smile, "boss, will he be proud of you blowing Lao he so much?"

"Tell the truth." Zheng Ren said, "I'm recovering well. Let's go back to the ward."

In the system operating room, the assistant cooperating with the operation should take Lao he as the template. Indeed, it took only 6 minutes in the warm-up phase of ECMO. Zheng Ren is just telling the truth, without any exaggeration.

"Dr. Zheng, do you have anything to pay attention to after operation?" Asked Dr. Nicole.

"One day later, recheck CT to see whether the tracheal lumen is unobstructed and how the stent position is. Two days later, recheck bronchoscope to see if the tracheal stent in the middle of the trachea has been completely re opened." Zheng Rendao said, "nothing else. The patient's dyspnea has been solved. The rest is to rest for a few days. After the body recovers, you can do the next treatment."

With that, Zheng Ren left the operating table, turned around, took off his sterile gloves and threw them into the bucket of medical waste.