"Boss, do you feel like something's missing when Old He isn't here?" Su Yun stood in the operating theater and asked with a smile as he prepared the equipment.
"Yes, I'm used to it," Zheng Ren said with a nod.
However, he could not bring the entire medical team with him every time he went out. That was illogical.
"You bragged about Lao He in Yang City. I heard from him that there's an academic conference on anesthesia this weekend. Director Qiu from Yang City will definitely come to meet Lao He," Su Yun said.
"I'm not bragging. Lao He's standard is definitely very high," Zheng Ren said. "Otherwise, he wouldn't have been able to separate the conjoined twins."
"It's all because of you."
"When did I scold Lao He?"
"Art is an exaggeration. Don't be so serious, okay?" Su Yun adjusted the operating table and asked, "The angle of the semi-reclining position can only reach this degree. Do you think it's okay?"
Zheng Ren nodded. "As long as the patient can accept it."
Generally speaking, the patient had to be in a supine position during surgery. However, the patient in front of them had problems with cardiopulmonary function because of the blockage of the airway and the lack of oxygen.
This was also a common characteristic of many patients with advanced lung cancer, also known as sitting breathing.
It was impossible to perform the surgery while lying down, so the surgeon could only reluctantly change the surgical position and choose a semi-reclining position.
Very soon, the patient was sent over and carried to the operating table. He was placed in a semi-reclining position with a mask to inhale 10 liters of oxygen per minute.
Seeing that the patient's oxygen saturation was good, Zheng Ren performed the surgery and scrubbed in with Su Yun.
The right femoral vein was punctured with a 28F venous catheter for drainage, and the left femoral artery was punctured with a 20F venous catheter for perfusion.
He waited for 30 minutes before activating VA-ECMO.
After ECMO was activated, Zheng Ren made a gesture.
However, he immediately realized that this was not in the country. Lao He was not by his side.
Su Yun noticed, laughed, and said: "Boss, you forgot right after I said it."
"Yes, I'm really used to it." After Zheng Ren said that, he began to communicate with Berta's anesthesiologist.
Propofol was administered intravenously for sedation, and the patient's position was changed to a supine position. The patient who was originally unable to lie flat did not show any abnormal reaction when he was placed into a lying position under the influence of ECMO.
His blood oxygen saturation was good, and his vital signs were stable. Everything was going well.
Only then did Su Yun let out a long sigh of relief. Standing in the operating room, Doctor Nico felt a sense of loss.
This idea was very simple. Why didn't he think of it? The same thought appeared in their minds at the same time.
"Su Yun, you keep an eye on ECMO. Lil Fugui and I will perform the surgery," Zheng Ren said.
"Yup, boss," Professor Rudolf Wagner replied cheerfully.
Su Yun didn't say anything, but kept staring at the machine. Circulatory system precharge — fresh plasma 100ml, Ringer's solution 400ml, heparin 2mg/kg, monitor MAP and SaO2 during circulation. The blood flow rate was 2.5L/min, and the SaO2 was maintained above 90%.
Everything was perfect. He made a gesture, indicating that Zheng Ren could start working.
The data displayed on the electrocardiogram was also satisfactory. A fiberoptic bronchoscope was inserted into the patient's nose.
Through the screen, Zheng Ren saw that the middle tracheal lumen had external pressure stenosis with a new organism in the lumen. The lumen was basically blocked. He began to select a guide wire and slowly sent it into the patient's airway.
As predicted, the airway was different from the esophagus. As long as the patient was still alive, it was impossible for the main airway to be completely occluded.
Although the airway path was distorted, Zheng Ren easily inserted the guide wire.
"Boss, step on the line or use the tracheoscope?" Su Yun asked.
"Step on the line." Zheng Ren still chose the safest method.
It was possible to simply use the tracheoscope to observe the patient's condition, but it was not as intuitive as the DSA machine.
The 18mm x 40mm nickel-iron alloy tracheal stent was placed in place, then released the stent and pulled out the stent implant. Zheng Ren began to absorb the bloody secretion and adjusted the stent position with the biopsy forceps. Under the DSA machine, the tracheal stent had been opened and the airway was cleared.
"You can stop ECMO now," Zheng Ren said.
Su Yun then began to communicate with the anesthesiologist, using protamine to neutralize and stop ECMO's operation.
ECMO's actual operation time was only 12 '26 seconds, and the surgery was completed easily.
A surgery that Berta had determined to be inoperable was completed just like that.
Zheng Ren was not in a hurry to send the patient back. He observed the patient in the operating room for a full 30 minutes, even longer than the actual surgery.
Su Yun was very impressed with the degree of caution.
"Doctor Zheng, your train of thought is amazing," Dr. Nico said to Zheng Ren as she entered the operating room. Doctor Zheng's surgical skills could not be seen in this surgery, but his alternative use of ECMO had opened up Dr. Nico's mind.
"Yes, the surgery is still a little slow. There are some problems with the patient's cooperation." Zheng Ren's eyes kept moving back and forth between the ECG monitor and the patient.
"You're already cooperating very well!" Dr. Nico said in surprise. Was Dr. Zheng telling the truth? The longest delay in the entire surgery was when he observed the patient postoperatively.
"If my anesthesiologist is here, the ECMO turnaround can be controlled to around six minutes," Zheng Ren said without looking at Dr. Nico.
Six minutes …
The number surprised Dr. Nico.
Only a well-trained medical team could control the activation time of ECMO within 15 minutes. For example, Doctor Zheng's activation time before the surgery was 30 minutes.
It was not a long time and was considered normal.
However, was six minutes really a good time?
"Oh my god …" Dr. Nico was surprised by Doctor Zheng's surgery and thought process, but she did not expect him to talk about the activation time of ECMO.
Was Doctor Zheng trying to tell her that his medical team was better than her and Alberta Private Hospital in every aspect?
Su Yun glanced at his boss and smiled. "Boss, won't Old He get arrogant if you praise him like that?"
"I'll be honest," Zheng Ren said. "He's recovering well. Prepare to send him back to the ward."
In the System's operating room, the assistant who cooperated with the surgery should be based on Old He. Indeed, it only took six minutes to warm up the ECMO. Zheng Ren was only telling the truth without any exaggeration.
"Doctor Zheng, is there anything to pay attention to after the surgery?" Dr. Nico asked.
"Check the CT scan in one day to see if the tracheal lumen is clear and the position of the stent. Check the bronchoscope again two days later to see if the stent has completely reopened, "Zheng Ren said. "There's nothing else. The patient's breathing difficulties have been resolved. All that's left is to rest for a few days and recover before the next step of treatment."
With that, Zheng Ren left the operating table, turned around, took off his sterile gloves, and threw them into the medical waste bin.
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