The shadowless lights in the operating room of the demonstration classroom came on. Su Yun stood in front of the operating table and complained, "Boss, if you don't change into isolation gowns and don't wear sterile gowns, there's no sense of ceremony at all."
"Then change. We probably have to squat here for a while. It will definitely be more comfortable if we change into isolation clothes." Zheng Ren replied nonchalantly.
"There's still half an hour before the printed lungs can be delivered."
"Don't worry, I still have something to do here. Lao He, come here." Zheng Ren greeted Lao He.
Lao He hurriedly ran over with a smile on his face, "Boss Zheng, please give instructions."
"When I was on ECMO, the pipes trembled. Do you have any good solutions?" Zheng Ren asked.
"It will happen with a high probability. 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 rate to cope with it." Lao He replied.
"Be careful here." Zheng Ren warned, and then he and Lao He began to study the dosage of anesthetic drugs.
There is a standard calculation formula for anesthetic dosage. The amount of anesthetic drug input is calculated based on kilogram of body weight or even body surface area.
But Xiao Shitou'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 based on the calculation results of the basic formula and reduced by a certain amount to avoid excessive damage to the body.
If you really dig into the most details, every medication and the pumping speed of every micropump will have a big statement.
Lao He listened cautiously at first, but as time went by, he spoke more and more.
Boss Zheng wants the most accurate values, the smallest surgical trauma and anesthesia impact.
On the basis of scientific calculations, Lao He combined his many years of clinical experience and made certain changes to the values that Zheng Ren had figured out in the system operating room.
Zheng Ren discussed with Lao He, and after having the numerical values, he went to the system operating room to get experimental questions to study.
At this point, Zheng Ren took full advantage of being a cheater.
The dose given by Lao He is only the limit that an anesthesiologist with rich clinical experience can achieve. It is just a guess, and it needs to be adjusted according to the actual situation during the operation.
Zheng Ren took Lao He's speculation to the system operating room without any scruples to verify it, and made more subtle adjustments after coming out.
Lao He didn't think there was anything abnormal about Boss Zheng's "deduction". In his opinion, Boss Zheng has already filled up his skill points in the ability of "deduction".
The visit to the Women's and Children's Hospital involved a lot of cooperation in anesthesia. Every time there was a difficulty, Boss Zheng would enter a meditative state. It's just that this state didn't last long, and he woke up with new views and perspectives.
Facts have proved that Boss Zheng’s opinion is right.
Lao He has 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 in detail.
This is what you have to do during the surgery.
"Boss, it's time for surgical training!" Su Yun greeted.
"Wait a minute, you guys come first, Lao He and I still have something to talk about." Zheng Ren shook his head and was still discussing anesthesia with Lao He.
The A4 paper in Lao He's hand has already been written on one and a half pages.
Su Yun came over and listened for a few words. The pipe tremor problem had been solved. The boss and Lao He were talking about the ventilator's assist value after starting ECMO assistance.
It's still early. After talking about the ventilator, there is still the question of whether to use extracorporeal circulation.
Lung transplantation is a surgery, but the surgical technique is not the most critical. It cares more about details. To succeed, everyone in the overall team must play their best role, from anesthesia to surgery to critical care in the ICU.
Su Yun knew that during lung transplant surgery, the ventilator was converted from a device that supports oxygenation and ventilation to a tool that reduces systemic inflammatory responses.
During ECMO diversion, both lungs still provide a small portion of gas exchange, but the ventilation strategy focuses on overexpansion or collapse and injury. As lung dependence decreases during ECMO, ventilator management shifts to a lung-protective strategy of lowering tidal volumes to ideal body weight.
Generally speaking, 6ml/Kg is an ideal value. But the boss was not satisfied with this "rough" theoretical value, and was still using cumbersome formulas with Lao He to calculate it. And this guy is constantly in a daze. Is his brain down
This time even Su Yun was dumbfounded.
Although low tidal volumes are a standard lung protection strategy, lowering the lung's driving pressure, that is, reducing the pressure difference between peak airway pressure and positive end-expiratory pressure, and avoiding lung tissue collapse are critical to recovery.
Collapsed lungs require higher pressures to overcome atelectasis, which is an effort to overcome the natural lag in hypoventilation. The resulting increase in pressure and loss of surfactant can further exacerbate the inflammatory response.
These details have gone beyond the scope of pure surgery and do not belong to the scope of anatomy, but to the content of physiology.
In the study of lung tissue, the boss is so meticulous, which makes the rising star of the Imperial Capital Cardiothoracic Surgery Department feel embarrassed.
Su Yun was quite powerless about this. He listened carefully for more than ten minutes. The various tedious formula calculations and the values calculated by Lao He based on many 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 the positive end-expiratory pressure based on the individual's peak airway pressure.
Su Yun understands the reason - since ECMO can directly deliver oxygen to the blood, the inhaled oxygen concentration of the ventilator can be reduced to a minimum to avoid oxygen toxicity.
Although there is no conclusion regarding the optimal mode and exact ventilator goals during ECMO assistance, traditional oxygenation goals are partial pressure of oxygen greater than 60 mmHg and oxygen saturation greater than 80%.
But tradition... has been smashed to pieces by the boss.
Making subtle adjustments again and again, the A4 paper in Lao He's hand already filled 3 pages.
"Boss, you study first. I'll take Lin Yuan and Xiao Ran to familiarize themselves with the surgery." Su Yun was helpless. Even after listening to so many things, his head felt a little uncomfortable.
As for Lao He, judging from the look of that guy, he might faint and die immediately after the research.
Zheng Ren and Lao He have almost finished their research, and he is quite satisfied with it. Anesthesia is the basis, especially for double-lung sequential transplantation assisted by ECMO.
Using the plan developed together with Lao He, Zheng Ren once again entered the system operating room and began surgical training.
The completion rate of the operation increased by 3-4 percentage points, and Zheng Ren felt very happy.
However, during the fifth surgical training, just as Zheng Ren began to anastomose the main trachea, the experimental subject's respiratory circulation suddenly changed dramatically.
Zheng Ren was confused for a moment. What went wrong in the process of achieving perfection? !