"Boss, anesthesia is a big problem." Su Yundao said, "The extracorporeal circulation team can only ask Lao He to do it first. We can't occupy one team member for such a long time."
"Well, when the time comes, Lao He will have to watch back and forth. If there is any problem between Ecmo and extracorporeal circulation, Lao He will have to keep an eye on it." Zheng Ren knew what Su Yun meant.
"Yes, because Lao He can't keep an eye on him, do you want to call Da Chu and Xiao Chu?" Su Yun asked.
"Is it convenient over there at home?"
"If you say it's okay, I'll ask again. Otherwise, when Da Chu and Xiao Chu come, you say no, that would be so embarrassing."
"Come on, let me talk to Director Xu. After all, it takes about a week of surgical training, and it's hard to find someone else from the anesthesiology department to accompany you all the time." Zheng Ren nodded and finalized the matter.
Lin Yuan and Gu Xiaoran are gearing up. Anyone who has worked in clinical practice for a period of time knows that this operation will definitely go down in history.
Autologous stem cell cloning and 3D-printed lung transplantation will definitely make a mark in the history of medicine, and may even turn into a big invisible hand that turns the pages of the history of modern medicine.
Wait for Yi and Lao He to go to the community hospital to prepare for surgical training.
The last time such exaggerated pre-operative training was during the cardiac separation surgery of conjoined twins at the Women's and Children's Hospital.
Overall, the operation is less difficult than separating conjoined hearts, but Zheng Ren is still prepared to go all out and spare no effort.
He even reunited the entire medical team without hesitation.
Watching Su Yun lead Gu Xiaoran and Lin Yuan to move the 3D printed manikin to the operating table in the demonstration classroom and make preoperative preparations, Zheng Ren took the opportunity to come to the system space and click to purchase surgical training time.
As the system operating room rose from the ground, Zheng Ren prayed silently in his heart, and then got in.
Fortunately, as imagined, the 3D printed cloned lung tissue is placed in the operating room, and there is no need to pay a high price to buy it in the system store.
Zheng Ren was very satisfied with this.
Surgery begins with anesthesia. Zheng Ren did not leave all this to Lao He. After all, there are fundamental differences between 3D printed simulations and real people.
Zheng Ren began to try anesthesia and put on ecmo.
First, give the experimental question a mask to inhale pure oxygen, with a volume fraction of 100%, and monitor the electrocardiogram and blood oxygen saturation. Zheng Ren then performed puncture and catheterization of the right radial artery to monitor invasive blood pressure and performed blood gas analysis.
For anesthesia induction, midazolam 1 to 2 mg and etomidate 0.2 to 0.2 mg were used for anesthesia induction. 4 mg/kg. Sufentanil 0.2～o. 4mg/kg and atracurium besylate 0.15～O. 3 mg/kg.
After entering the muscle relaxation state, tracheal intubation was started and a ventilator was connected to assist breathing.
Anesthesia was maintained by intravenous infusion of propofol 0.03 to 0.05 nag·kg. 1·min, vecuronium bromide 1～2ug/kg/·min. And indirect intravenous injection of fentanyl was performed to maintain anesthesia.
Zheng Ren observed the condition of the experimental subjects for a period of time and conducted blood gas analysis intermittently.
The blood gas values were not stable because the ventilation methods were all pressure-controlled, so Zheng Ren adjusted the ventilation parameters based on the blood gas analysis indicators and vital signs, and decided to perform manual ventilation when necessary.
After induction of anesthesia, the right femoral artery and vein were cannulated. The femoral artery was cannulated with a 15-17 Fr catheter to the level of the common iliac artery; the femoral vein was cannulated with a 19-21 Fr catheter to the level of the inferior vena cava. Use fully heparin-coated membrane lungs and pipes, thermostats, centrifugal pump heads and oxygenators. Diversion begins once the catheter is placed.
The maximum flow rate of ECMO is usually determined by intubation. Each cannula has its own unique flow-pressure curve. The larger the cannula, the higher the flow rate. For example, a 17-gauge arterial cannula can only achieve a flow rate of 4 to 5 liters per minute, while a 21-gauge cannula can achieve a flow rate of 6 liters per minute without causing additional pressure on the wall.
Considering Xiao Shitou's age, Zheng Ren tried many times and finally chose the most suitable model of intubation.
The initial flow rate is 50% of the intermittent cardiac output, and is maintained at more than 30% during the diversion period. During the operation, the speed and flow rate are adjusted according to oxygenation and cardiac function.
Zheng Ren did not buy an assistant to help him with the surgery. This time he was just trying to gain experience. Although there is a lot of time left for surgical training, Zheng Ren is not ready to "waste" it.
For this operation, Zheng Ren did not think that the 3D printed cloned lung tissue could be perfectly qualified. If there was an abnormality, he was going to take Su Yun away, and then "hid it from the truth" and replace the 3D printed lung tissue brought by Su Yun's familiar laboratory with the lung tissue in the system space.
This was very risky, but Zheng Ren had already prepared for the worst in order for the operation to be successful.
The lung tissue that can be taken out for transplantation can only be exchanged for hundreds of thousands of experience points, which is more expensive than what was used in the system space before.
Let's do it bit by bit, hoping that the lung tissue provided by Su Yun will be more reliable.
When the operation began, Zheng Ren discovered an abnormality.
Before the ECMO flow rate dropped, he observed a "pipeline tremor" phenomenon.
This is a phenomenon caused by the negative pressure within the ECMO circuit causing the venous cannula to hit the venous wall when the intravascular volume state is at a low level.
Continuous tremors may cause ECMO alarms or "wall suction until flow decreases." After Zheng Ren lowered the ECMO flow rate, he found that the tremor amplitude could be quickly relieved; he then solved this problem by slowly increasing the ECMO flow rate while expanding the capacity.
Normally speaking, the phenomenon of pipe tremor is not uncommon in the use of ecmo. I think Lao He must have encountered it many times. However, Zheng Ren was very careful to solve the problem of pipeline tremor bit by bit. He knew exactly how to expand the capacity and how much dose to give to avoid pipeline tremor.
Just one detail wasted 30 hours of surgical training time.
As surgeries become larger and larger, more and more surgical training time is consumed. Fortunately, there are 3D printed simulators available for training. Otherwise, if you buy an assistant in the system operating room, you won’t be able to train a few times in a series.
However, what makes Zheng Ren more gratified is that the 3D printed cloned lung tissue brought by Su Yun is quite good. After completing the operation, the system actually gave an 88% completion rate of the operation.
This degree of completion is relatively low among the surgeries Zheng Ren has performed, but one thing Zheng Ren has proven is that there is no essential difference between 3D printed tissue and tissue purchased in the system space.
As long as everything is fine, Zheng Ren doesn't want to transform into a living person and create lung tissue and organs.
A laryngoscope, a blade, these are small things, you can explain them however you want. Even if Su Yun or others had doubts, they would think that Zheng Ren had obsessive-compulsive disorder and it was just a coincidence.
But conjuring up a lung...
Are you selling human organs? In that case, as long as someone notices it, the consequences will be disastrous.
Cloned lungs should work. This is the best news Zheng Ren has ever received.
After 62 hours of surgical training, Zheng Ren felt that his level was really good. Organ transplant specialization, although Big Pig Hoof did not give an explanation, Zheng Ren is sure that this specialization skill plays a big role.