After entering the operating room, Lao He took Xiao Shitou in, while Zheng Ren and Su Yun went to change clothes.
"Boss, are you really going to stay in the ICU for a few days and nights?" Su Yun asked.
"Well." Zheng Ren said, "It's better for me to take care of you. Don't leave either. Although our 912 team is very strong in severe cases, they are 3D-printed lungs after all. It's not certain that anything will happen. I don't feel at ease with them. .”
Su Yun's lips moved and he wanted to say something, but in the end he held back.
Others entered the operating room early in the morning to prepare. The entire medical team attached great importance to this operation. Even Gao Shaojie offered to help and stopped today's tips operation.
This request was rejected by Zheng Ren, so Gao Shaojie and Zhou Chunyong had to go for the operation. The others arrived at the operating room of the Department of Surgery early in the morning and used the innermost hybrid operating room to start preparations.
It took a week to prepare for this operation, but when it came time to go on stage, Zheng Ren felt a sense of home away from home. After changing clothes in silence, Zheng Ren and Su Yun walked into the operating room.
Director Xu stood at the door of the operating room. Seeing Zheng Ren come in, he smiled bitterly and said, "Boss Zheng, where did you find the traveling nurse?"
"Ah?" Zheng Ren thought Director Xu was going to ask if there was anything he could do to help, but he didn't expect him to ask such a question.
"Training nurses from abroad." Su Yun answered smartly and directly.
"I'm not even allowed in." Director Xu complained.
"Uh..." Zheng Ren was speechless, "I told her yesterday to keep as few people as possible to avoid damaging the sterile environment. Sorry, Director Xu."
"Boss Zheng, you won't have to take care of the traveling nurses yourself in the future." Director Xu said half-jokingly and half-seriously.
"I don't know." Zheng Ren was also confused about this matter.
"Chu Lin said this is a foreign friend with a big background." Director Xu asked in a low voice.
"Well, you should be considered a patient of mine."
While talking, the three of them came to the operating room. Maris is preparing various things for the operation. After a period of training and adaptation in the past few days, she is as skilled as a 912 nurse.
Today, Maryse is wearing an isolation suit. After a period of treatment, the fat on her lower body was removed, and she has regained a figure she is proud of; or to be more precise, she has transformed into the look that Kerry helped her customize.
Zheng Ren's cosmetic plastic surgery was quite good. At least looking at the back, one would have thought she was a supermodel from some company busy in the operating room. She couldn't tell that she used to look like a devil with her lower body like a mountain of meat and her upper body withered like a skeleton.
"Marys, this is Director Xu, the leader here." Zheng Ren introduced him to Marys after he came in.
Maris turned her head and asked, "Leader? Brother Yun, what is that?"
Su Yun frowned when he heard her question. The atmosphere was a bit awkward, and Zheng Ren felt that he was worse than the professor who was full of dirt. At least the professor is a doctor. He understands the rules of the operating room and will never conflict with the people who manage the operating room.
"Can he come in?" Maris also felt the awkwardness in the atmosphere, and she asked later.
"Come in..." Zheng Ren arrived, "Director Xu, do you have time to help?"
"Yes." Director Xu's voice was a little dry. This was the 912 operating room. It was unreasonable for him to have permission to enter! If it weren't for Boss Zheng's request, he would definitely go crazy.
"Sorry to trouble you," Zheng Ren said.
"Zheng, is there anyone else?" Maris asked seriously and stubbornly, "Too many people coming in is not conducive to sterility. That's what the book says."
"Dr. Charles will be here soon, and the rest will be gone." Zheng Ren said helplessly.
Zheng Ren said something to Xiao Shitou, and then looked at Lao He.
Lao He was already prepared. He nodded and prepared for anesthesia.
"Wait a moment, I'm going to clean my hands first." Zheng Ren said, "I will direct this operation from the beginning."
Lao He didn't say anything about Boss Zheng's weird request. More than 20 pages of A4 paper were not enough. Boss Zheng had to give instructions from scratch. It seemed a bit too cautious.
Sometimes Lao He felt that Boss Zheng was different from others in treating the little patient in front of him.
Zheng Ren strode out to wash his hands and came back to put on his clothes. The song of good luck had already started to sound. It was not loud and was more of a background.
Dr. Charles started the operation and came to the operating room. Ringer accompanied the doctor and explained to him the 912 operating room.
Zheng Ren narrowed his eyes and smiled, but did not talk to the doctor much.
"Puncture the radial artery and do blood gas analysis. Leave a sample first." Zheng Ren put on his clothes and stood in the corner and said.
Lao He and his assistant quickly started the operation. Su Yun, Lin Yuan, and Gu Xiaoran had already started laying out sterile drape in preparation for ECMO placement.
"Midazolam 1 mg, etomidate 0.15 mg/kg. Sufentanil 0.15 mg/kg, atracurium besylate 0.12 mg/kg." Zheng Ren said in a deep voice.
The dosage of these drugs was the result of several days of discussion with Lao He and Zheng Ren's hundreds of attempts in the system operating room, so he was already familiar with them. But Zheng Ren cautiously took over the command of the operation for the first time and did not even give up anesthesia.
Lao He started taking medication, and after muscle relaxation, he underwent endotracheal intubation and was connected to a ventilator for mechanical ventilation. The left double-lumen bronchial tube was selected as the tracheal tube.
Zheng Ren also explained the values of various ventilators, and then intravenously infused propofol 0.02 nag/kg/·min, vecuronium bromide 1ug/kg/·min, and intermittent intravenous injection of sufentanil.
After the anesthesia took effect, Su Yun took Lin Yuan to ECMO.
The right femoral artery and vein were cannulated. The femoral artery was cannulated with a 15 Fr catheter to the level of the common iliac artery; the femoral vein was cannulated with a 19 Fr catheter to the level of the inferior vena cava. Use fully heparin-coated membrane lungs and pipes, thermostats, centrifugal pump heads and oxygenators.
The diversion was started after the catheter was inserted. The initial flow was 2.5 L·min-1·m-2 of the intermittent cardiac output and was maintained above 30% during the diversion period.
Seeing that Xiao Shitou's vital signs were stable and his blood oxygen saturation was rising, Zheng Ren began to lay out sterile drape and prepare for surgery.
The operating room was quiet, with only the sound of good luck songs floating around.
After preparing for the operation, Zheng Ren stood in the position of the surgeon and recalled the mature operation process. After preparing the electric cautery and suction device, he stretched out his hand.
The iodophor gauze held by the hemostatic forceps was patted in Zheng Ren's hand.
Disinfect, incise, and make anterolateral incisions on both sides of the thorax + sternum transection. The incision is made through the 4th or 5th intercostal space on both sides, from the mid-axillary line to the sternal edge, and then transects the sternum.
This incision can provide sufficient exposure of both sides of the thorax from the pleural roof to the diaphragm and the posterior mediastinum, making it easy to free the lungs and hilar structures. Although some people have suggested in recent years that there is no need to transect the sternum, Zheng Ren chose the most "old" method after surgical experiments.
Although the damage caused by this method is a little larger, the surgical process is significantly shortened and is more suitable for small stones.
"Boss, are you nervous?" Su Yun stood opposite Zheng Ren and felt that the atmosphere in the operating room was a bit solemn, so he asked with a smile.
"It's okay." Zheng Ren narrowed his eyes and answered with a smile.