"Boss, do you feel like you missed something when Lao He is away?" Su Yun asked with a smile while standing in the operating room, preparing the instruments.
"Well, I'm used to it." Zheng Ren nodded and said.
But you can't bring the entire medical team with you every time you travel. That's unreasonable.
"You played Lao He once in Yangcheng. I heard him say that there is an academic conference on anesthesia this weekend. Director Qiu from Yangcheng will definitely come to meet Lao He." Su Yundao.
"I'm not bragging, Lao He's level must be very high." Zheng Ren said, "Otherwise, the heart separation operation for the conjoined twins wouldn't have been possible."
"It's not because you scolded me."
"When did I ever scold Lao He?"
"Art is exaggerated, please don't be so realistic, okay?" Su Yun adjusted the operating table and asked: "The angle of the semi-recumbent position can only be as high as it is now. Do you think it will work?"
Zheng Ren nodded, "As long as the patient can accept it."
Generally speaking, surgery requires a supine position, but the patient in front of me could not lie down due to a blocked airway and low oxygen intake, as well as cardiopulmonary function problems.
This is also a common characteristic of many patients with advanced lung cancer, also called orthopnea.
It was impossible to perform the surgery while lying down, so the surgeon had to deal with it reluctantly, changing the surgical position and choosing a semi-recumbent position.
The patient was quickly delivered and was carried to the operating table. He was placed in a semi-recumbent position and was receiving oxygen through a mask, with the oxygen level being 10 liters per minute.
Seeing that the patient's blood oxygen saturation was good, Zheng Ren performed an operation and brushed his hands with Su Yun to prepare for the operation.
The right femoral vein was percutaneously punctured and a 28F venous cannula was inserted for drainage, and the left femoral artery was percutaneously punctured and a 20F femoral artery cannula was inserted for perfusion.
Then I waited quietly for 30 minutes to start VA-ECMO.
After ECMO was 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 just forgot about it."
"Well, I'm really used to it." After Zheng Ren finished speaking, he began to communicate with Bota's anesthesiologist.
Basic anesthesia and sedation with propofol was administered intravenously, and the patient's position was subsequently changed to a supine position. Patients who were originally unable to lie down did not experience any abnormal reactions when they entered a supine state under the influence of ECMO.
Oxygen saturation was good, vital signs were stable, and everything was going well.
Only then did Su Yun let out a sigh of relief, and Dr. Nico stood in the operating room feeling lost.
This idea is very simple, why didn’t I think of it myself? An idea emerged in their minds at the same time.
"Su Yun, you keep an eye on the ECMO while Fugui'er and I do the surgery." Zheng Ren said.
"Yes, boss." Professor Rudolf Wagner responded cheerfully.
Su Yun didn't say anything more, but kept staring at the machine. Circulation system pre-charge - 100 ml of fresh plasma, 400 ml of Ringer's solution, 2 mg/kg of heparin, and monitor MAP and SaO2 during the transfer. The blood flow rate is 2.5L/min, keeping SaO2 above 90%.
Everything was perfect, and he made a gesture to indicate that Zheng Ren could start operating.
The data displayed on the ECG monitoring were also very satisfactory to Zheng Ren, and the patient had a fiberoptic bronchoscope inserted through the nose.
Zheng Ren saw through the screen that the middle part of the trachea had extra-luminal pressure stenosis accompanied by intraluminal neoplasms, and the lumen was basically blocked. He began to select the guidewire and slowly inserted it along the patient's airway.
As predicted before, the airway is different from the esophagus, and it is impossible for the main airway to be completely occluded as long as the patient is alive.
Although the airway passage was twisted, Zheng Ren easily inserted the guide wire.
"Boss, should I use a bronchoscope to step on the line?" Su Yun asked.
"Step on the line." Zheng Ren still chose the safest way.
It is also possible to simply use a bronchoscope to observe the stent to see the patient's condition, but it is not as intuitive as the DSA robot.
The 18mm×40mm nickel-iron alloy tracheal stent is delivered to the location, then the stent is released and the stent implanter is pulled out. Zheng Ren began to aspirate bloody secretions and used biopsy forceps to adjust the position of the stent. Under the DSA machine, it could be seen that the tracheal stent had been opened and the airway was restored to smoothness.
"ECMO can be stopped." Zheng Ren said.
Su Yun then began to communicate with the anesthesiologist here, neutralizing it with protamine and stopping the operation of ECMO.
The actual running time of ECMO is only 12′26 seconds, and the operation is completed simply.
An operation that Bota judged to be inoperable was completed smoothly.
Zheng Ren did not rush to send the patient back and observed him in the operating room for a full 30 minutes. The observation time was even longer than the formal operation time.
Su Yun was very convinced that he was so cautious.
"Dr. Zheng, your thinking is really amazing." Dr. Nico walked into the operating room and communicated with Zheng Ren. Dr. Zheng’s surgical skills cannot be seen in this surgery, but mainly the alternative use of ECMO, which opened up Nico’s mind.
"Well, the operation process is still a bit slow, and there is a problem with cooperation." Zheng Ren kept looking back and forth between the ECG monitor and the patient.
"The cooperation has been very good!" Dr. Nico said in surprise. Is Dr. Zheng telling the truth? The longest delay in the entire operation was during his postoperative observation of the patient.
"The ECMO transition can be controlled to about 6 minutes if my anesthesiologist comes." Zheng Ren didn't even look at Dr. Nico and just chatted casually.
6 minutes…
This number surprised Dr. Nico.
Only a well-trained medical team can control the start-up time of ECMO within 15 minutes, and for example, Dr. Zheng's start-up time before surgery this time was 30 minutes.
This time is not long, it is just normal.
But 6 minutes, is this really good
"Oh my god..." Dr. Nico was originally surprised by Dr. Zheng's surgery and ideas, but she didn't expect that he was talking to her about the start time of ECMO.
Could it be that Dr. Zheng was telling himself that his medical team surpassed him and Bota Private Hospital in all aspects
Su Yun glanced at his boss and said with a smile: "Boss, if you brag about Lao He like this, will he be proud?"
"Tell the truth." Zheng Ren said, "The recovery is not bad. Prepare to be sent back to the ward."
In the system operating room, the assistant who cooperated with the operation should be based on Lao He. Indeed, the ECMO warm-up phase only took 6 minutes. Zheng Ren just told the truth without any exaggeration.
"Dr. Zheng, is there anything I should pay attention to after the operation?" Dr. Nico asked.
"Recheck the CT in 1 day to see if the tracheal lumen is open and how the stent is positioned. Review the bronchoscope in 2 days to see if the tracheal stent in the middle part of the trachea has been fully recruited." Zheng Ren said, "There is nothing else. The patient is breathing The difficult situation has been resolved, and all that remains is to rest for a few days, and then the body can recover before proceeding with the next step of treatment."
After saying that, Zheng Ren left the operating table, turned around, took off his sterile gloves, and threw them into the bucket of medical waste.