Chapter 2961

The shadowless light in the operating room of the classroom came on. Su Yun stood in front of the operating table and complained, "boss, there is no sense of ceremony without changing isolation clothes and wearing sterile clothes."

"Then change it. We'll squat here for a while. If we change our isolation clothes, we'll be more comfortable." Zheng Ren replied indifferently.

"It's half an hour before the printed lungs can be delivered."

"Don't worry, I have something else to do. Lao he, you come." Zheng Ren greets Lao he.

Lao he hurriedly ran over and smiled, "boss Zheng, your instructions."

"When you go to ECMO, the pipeline vibrates. Do you have any good solutions?" Zheng Ren asked.

"The probability will occur. There is no way to predict the frequency and intensity of tremor in advance. We can only adapt to the situation during the operation and constantly adjust the flow." Lao he replied.

"Be careful with this one." Zheng Ren asked, and then began to study the dose of narcotic drugs with Lao he.

There is a standard calculation formula for the amount of narcotic drugs. The input amount of narcotic drugs is calculated according to kg body weight or even body surface area.

But little stone's situation is slightly special. Although he has gained some weight recently and looks closer to a normal child, he must not be regarded as a normal person.

The dosage of medication should also be changed in the calculation results of the basic formula to reduce a certain amount, so as not to cause too much damage to the body.

If you really dig into the most details, there are big statements about the pumping speed of each medication and each micro pump.

Lao he began to listen carefully, but as time went on, he said more and more.

Boss Zheng wants the most accurate value, the smallest surgical trauma and anesthetic blow.

On the basis of scientific calculation, Lao he combined his rich clinical experience for many years and changed the value found out by Zheng Ren in the system operating room.

While Zheng Ren discussed with Lao he, after having the numerical value, he went to the system operating room to get the experimental problem for research.

At this point, Zheng Ren gave full play to the advantage of hanging force.

The dose given by Lao he is only the limit that an anesthesiologist with rich clinical experience can achieve. It is just speculation. The specific needs to be adjusted according to the situation during the operation.

Zheng Ren took Lao he's conjecture to the system operating room for verification, and made more subtle adjustments after coming out.

For boss Zheng's "deduction", Lao he doesn't think anything is abnormal. In his opinion, the ability of "deduction" boss Zheng has been full of skill points.

The women's and children's hospital involved a lot of cooperation in anesthesia. Every time there were difficulties, boss Zheng would enter a state of meditation. But this state did not last long, he woke up and had new views and views.

Facts have proved that the opinions put forward by boss Zheng are right.

Lao he always admired boss Zheng for this, so he simply took out a pen and paper and wrote down the results of boss Zheng's deduction.

This is what you have to do during the operation.

"Boss, I've had surgery training!" Su Yun said hello.

"Wait a minute, you come first. Lao he and I have something to say." Zheng Ren shook his head and was still studying anesthesia with Lao he.

Lao he has written one and a half pieces of A4 paper in his hand.

Su Yun came over and listened. The problem of pipeline tremor has been solved. The boss and Lao he are talking about the auxiliary value of ventilator after ECMO assistance.

It's still early. After talking about the ventilator, there's still the question of whether cardiopulmonary bypass should be used or not.

Lung transplantation is said to be an operation, but the operation method is not the most critical. It pays more attention to the details. If you want to succeed, everyone in the whole team should play their greatest role, from anesthesia to surgery to ICU.

Su Yun knows that in lung transplantation, the ventilator is transformed from a device supporting oxygenation and ventilation to a tool to reduce systemic inflammatory response.

During ECMO bypass, both lungs still provide a small part of gas exchange, but the ventilation strategy is mainly aimed at excessive expansion or collapse and injury. With the reduction of lung dependence during ECMO, ventilator management changed to a lung protection strategy to reduce the tidal volume corresponding to the ideal body weight.

Generally speaking, 6ml / kg is an ideal value. But the boss is not satisfied with this "rough" theoretical value, and he is still calculating it with cumbersome formulas. And the goods are constantly "in a daze". Is the brain down?

This time even Su Yun looked silly.

Although low tidal volume is the standard lung protection strategy, reducing the driving pressure of the lung, that is, reducing the pressure difference between peak airway pressure and positive end expiratory pressure, and avoiding lung tissue collapse, are very key to recovery.

Collapsed lungs need higher pressure to overcome atelectasis, which is to overcome the natural lag when ventilation is insufficient. The resulting pressure rise and loss of surfactant will further aggravate the inflammatory response.

These details have been separated from the scope of simple surgery, and do not belong to the scope of anatomy, but the content of physiology.

In the study of lung tissue, the boss is so meticulous, which makes the future star of imperial cardiothoracic surgery feel embarrassed.

Su Yun is quite powerless about this. He listened carefully for more than ten minutes. All kinds of cumbersome formula calculations and the value calculated by Lao he based on years of rich clinical experience seemed to him to be an almost perfect anesthesia operation, but the boss was not satisfied at all.

He is adjusting positive end expiratory pressure based on individual peak airway pressure.

Su Yun knows the truth - because ECMO can directly deliver oxygen to the blood, the oxygen concentration inhaled by the ventilator can be reduced to the lowest to avoid oxygen toxicity.

Although there is no conclusion on the best mode and exact target of ventilator during ECMO assistance, the traditional oxygenation target is oxygen partial pressure greater than 60mmhg and oxygen saturation greater than 80%.

But tradition... Has been smashed by the boss.

Make subtle adjustments again and again. The A4 paper in Lao he's hand has been filled with three pages.

"Boss, you study first. I'll take Lin Yuan and Xiao ran to get familiar with the operation first." Su Yun was very helpless. Even after listening to so many things, his brain was a little uncomfortable.

As for Lao he, looking at the goods, I'm afraid he can't faint directly after the study.

Zheng Ren has studied almost as much as Lao he, and he is also quite satisfied with it. Anesthesia is the basis, especially in the sequential double lung transplantation assisted by ECMO.

Using the scheme developed with Lao he, Zheng Ren entered the system operating room again and began surgical training.

The completion of the operation increased by 3-4 percentage points, and Zheng Ren felt very happy.

However, during the fifth operation training, Zheng Rengang began to anastomose the main trachea, and the respiratory circulation of the experimental body changed dramatically.

Zheng Ren suddenly lost his mind. He was originally trying to achieve perfection. What's wrong with this?!