MTL - Live Surgical Broadcast

The shadowless lamp in the operating room of the classroom was lit, and Su Yun stood in front of the operating table and complained, "Boss, I do n’t have any sense of ritual if I do n’t change the isolation clothes and do n’t wear sterile clothes.

"Then change 呗, we estimate that we have to squat for a while on this side. It will definitely be more comfortable if you change the isolation clothing." Zheng Ren answered indifferently.

"There is still half an hour before the printed lungs can be delivered."

"Don't worry, there's something else on my side. Lao He, come here." Zheng Ren greeted Lao He.

Laohe rushed over and smiled, "Boss Zheng, you instruct."

"When you went to ecmo, there was a pipeline tremor. Do you have any good solutions?" Zheng Ren asked.

"There is a high probability that there will be no way to estimate the frequency and intensity of the tremor in advance. It can only be adjusted during the operation to adjust the flow constantly to respond." Lao He replied.

"Be careful with this one." Zheng Ren instructed, and then began to study the dosage of anesthetic drugs with Lao He.

Anesthesia dose has a standard calculation formula, and the input of anesthetic drugs is calculated according to kilogram body weight and even body surface area.

But the situation of Little Rock is a little bit special. Although he has become fatter recently and looks closer to a normal child, he must not be regarded as a normal person.

The dosage of the medicine should be changed in the calculation result of the basic formula, and a certain amount should be reduced, so as not to cause excessive damage to the body.

If you go to the most detailed place, there is a lot to say about the pumping speed of each medication and every micropump.

Laohe started to listen carefully, but with time, he said more and more.

Boss Zheng wants the most accurate values, the smallest surgical trauma, and anesthesia.

科学 On the basis of scientific calculations, Lao He combined his many years of rich clinical experience and made certain changes to the values ​​figured out by Zheng Ren in the system operating room.

仁 While Zheng Ren discussed with Lao He, he went to the system operating room to get experimental questions to study after having the values.

At this point, Zheng Ren gave full play to an aggressive advantage.

The dose given by Wu Laohe is just the limit that an anesthesiologist with rich clinical experience can do, it is only speculation, and the specific needs to be adjusted according to the situation during the operation.

仁 And Zheng Ren took Lao He's speculation without hesitation to go to the system operating room for verification. After he came out, he made more detailed adjustments.

Lao He didn't think anything abnormal about Mr. Zheng's "deduction". In his opinion, the ability to "deduct" Boss Zheng was already full of skill points.

That time, the daughter-in-law hospital involved a lot of cooperation in anesthesia. Every time there was a difficulty, Boss Zheng would enter a meditation state. It was just that this state was not maintained for a long time, and he woke up with new ideas and opinions.

Facts have proved that the opinions of Boss Zheng are correct.

Lao He has always admired Boss Zheng, so he simply took out a pen and paper and wrote down the results of Boss Zheng's deduction.

This is what I have to do during the operation.

"Boss, you have surgery training!" Su Yun greeted.

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

Laohe has written a piece of A4 paper in half.

Wu Suyun came over and listened to a few words, the problem of pipeline tremor has been resolved, the boss and Lao He are talking about the auxiliary value of the ventilator after starting ECMO assistance.

早 It's too early. After talking about the ventilator, there is still the question of whether to perform extracorporeal circulation.

Lung transplantation is surgery, but the technique of surgery is not the most critical. It pays more attention to the details. If you want to succeed, from anesthesia to surgery to ICCU, everyone in the overall team must play its best role.

Qi Suyun knew that during lung transplantation, the ventilator changed from a device that supports oxygenation and ventilation to a tool to reduce the systemic inflammatory response.

During ECMO diversion, both lungs still provide a small portion of gas exchange, but the ventilation strategy is mainly aimed at excessive expansion or collapse and injury. As lung dependence decreases during ECMO, ventilator management shifts to a lung protection strategy that reduces the tidal volume corresponding to the ideal weight.

Generally speaking, 6ml / Kg is a relatively ideal value. But the boss was not satisfied with this "rough" theoretical value, and he and Lao He used a cumbersome formula to calculate it. And the goods are constantly "stunned", is the brain down?

Even Su Yun was foolish this time.

Although low tidal volume is a 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 collapse of lung tissue, are critical to recovery.

Collapsed lungs require higher pressure to overcome atelectasis, which is to overcome the natural lag in hypoventilation. The resulting increase in pressure and loss of surfactant can further exacerbate the inflammatory response.

细节 These details have departed from the scope of pure surgery, and do not belong to the scope of anatomy, but the content of physiology.

老板 In the study of lung tissues, the boss turned out to be so delicate, which made Emperor Cardiothoracic Surgery's tomorrow's star love.

Qi Suyun was quite powerless. He listened carefully for more than ten minutes. Various cumbersome formula calculations and the values ​​calculated by Lao He based on many years of rich clinical experience seemed to him to be a near-perfect anesthesia operation ~ www. ~ but the boss Not satisfied at all.

• He is adjusting the positive end-expiratory pressure based on the individual's peak airway pressure.

The reason is that Su Yun understands that-because ECMO can directly deliver oxygen to the blood, the inhaled oxygen concentration of the ventilator can be minimized to avoid oxygen toxicity.

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

But tradition ... has made the boss mess up.

的 Make fine adjustments again and again, A4 paper in Lao He's hand has been filled with 3 pages.

"Boss, you study first, I took Lin Yuan and Xiao Ran to get familiar with the operation first." Su Yun was very helpless, even after he heard so many things, his head was a little bit upset and uncomfortable.

As for Lao He, depending on the appearance of the goods, I am afraid that I will not faint directly after the study.

Zheng Ren has already studied with Lao He, and he is quite satisfied with it. Anesthesia is the foundation, especially for sequential lung transplantation with the assistance of ECMO.

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

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

But at the time of the 5th surgical training, Zheng Ren just started to fit the main trachea, and the subject's breathing cycle even changed drastically.

Zheng Ren suddenly stunned. What went wrong? !!