Chapter 2963

The shadowless light in the operating room of the classroom was turned on. Su Yun stood in front of the operating table and complained, "Boss, if you don't change the isolation suit or the sterile gown, there is no sense of ceremony at all."

"Then change it. We'll probably have to squat here for a while. It will definitely be more comfortable after changing the isolation suit." Zheng Ren replied indifferently.

"There is 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 hurried over, smiling all over his face, "Boss Zheng, please give me instructions."

"During the ecmo, the pipeline 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 the tremor in advance. We can only adapt to the situation during the operation and constantly adjust the flow to deal with it." Lao He replied.

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

There is a standard calculation formula for the anesthetic dose, and the input amount of anesthetic drugs is calculated according to kilograms of body weight or even body surface area.

But Xiaoshi's situation is slightly special. Although he has gained weight recently and looks closer to a normal child, he must not be regarded as a normal person.

The dose of medication should also be changed based on the calculation results of the basic formula, and the amount should be reduced to avoid excessive damage to the body.

If you really dig into the most details, there will be a big statement about the pumping speed of every drug and every micropump.

At the beginning, Lao He carefully pricked up his ears to listen, but as time went by, he said more and more.

Boss Zheng wants the most accurate value, the least surgical trauma and anesthesia blow.

On the basis of scientific calculations, Lao He combined his years of rich clinical experience, and made some changes to the values ​​that Zheng Ren found out in the operating room of the system.

While discussing with Lao He, Zheng Ren went to the system operating room to study the experimental questions after getting the numerical values.

At this point, Zheng Ren fully utilized the advantage of being a coward.

The dose given by Lao He is only the limit of what an anesthetist with rich clinical experience can do.

And Zheng Ren took Lao He's conjecture without any scruples to the system operating room for verification, and made more subtle adjustments after he came out.

For Boss Zheng's "deduction", Lao He didn't think there was anything abnormal. In his opinion, Boss Zheng has already maxed out the skill points of the ability of "deduction".

The time at 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 state of meditation. It's just that this state didn't last long before he woke up with new views and perspectives.

Facts have proved that Boss Zheng's opinion is correct.

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.

This is what you do in surgery.

"Boss, it's time for surgery 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, still discussing anesthesia with Lao He.

The A4 paper in Lao He's hand has already written one and a half pages.

Su Yun leaned over and listened to a few words. The problem of the pipe tremor had been solved. The boss and Lao He were talking about the assistance value of the ventilator 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 said to be an operation, but the operation method is not the most critical. It cares more about the details. To be successful, from anesthesia to surgery to severe ICU, everyone in the overall team must play their best role.

Su Yun knew that during lung transplantation, the ventilator was converted from a device that supports oxygenation and ventilation to a tool to reduce systemic inflammatory response.

During ECMO bypass, both lungs still provide a small amount of gas exchange, but the ventilation strategy is mainly aimed at hyperinflation or collapse and injury. As the dependence on the lungs decreases during ECMO, ventilator management shifts to a lung-protective strategy down to tidal volumes corresponding to ideal body weight.

Generally speaking, 6ml/Kg is an ideal value. But the boss is not satisfied with this "rough" theoretical value, and is still calculating with Lao He using cumbersome formulas. And this guy is constantly "in a daze", is the brain down?

This time even Su Yun was dumbfounded.

Although low tidal volumes are the standard lung-protective strategy, lowering the driving pressure of the lungs, 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 to overcome the natural hysteresis of hypoventilation. The resulting increase in pressure and loss of surfactant further exacerbates the inflammatory response.

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

In the study of lung tissue, the boss is so meticulous, which makes the rising star of the Cardiothoracic Surgery Department of the Imperial City very embarrassed.

Su Yun was quite powerless about this. He listened carefully for more than ten minutes. All kinds of cumbersome formula calculations and the values ​​calculated by Lao He based on years of rich clinical experience are already a nearly perfect anesthesia operation in his opinion, but the boss is not satisfied at all.

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

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

Although no conclusions have been drawn regarding the optimal mode and exact goals of the ventilator during ECMO assistance, traditional oxygenation goals have been partial pressure of oxygen greater than 60 mmHg and oxygen saturation greater than 80%.

But the tradition...has been smashed by the boss.

After making subtle adjustments again and again, the A4 paper in Lao He's hand has filled three pages.

"Boss, you study first, I will take Lin Yuan and Xiao Ran to familiarize yourself with the operation first." Su Yun was very helpless, even after hearing so many things, his mind was a little swollen and uncomfortable.

As for Lao He, judging by that guy's appearance, he might faint to death after the research.

Zheng Ren has already done almost the same research as Lao He, and he is quite satisfied with it. Anesthesia is the basis, especially for double-lung sequential transplantation assisted by ECMO.

Using the plan developed with Lao He, Zheng Ren once again entered the operating room of the system to start surgical training.

The degree of completion of the operation has increased by 3-4 percentage points, and Zheng Ren feels very happy.

However, during the fifth surgical training, Zheng Ren had just started to anastomose the main trachea, and the experimental subject's breathing cycle unexpectedly changed dramatically.

Zheng Ren was stunned. What went wrong in the original perfect process? !