super anesthesiologist

Chapter 26 Paraspinal nerve block (please recommend, please collect, thank you!)

"You want to give grandpa an epidural?" Liu Xu's eyes widened in shock.

She was wearing a mask, and Lin Xiaobei could imagine that there must be a closed mouth hidden inside.

Neuraxial anesthesia for patients undergoing thoracic surgery?If this gets out, Director Lin will severely criticize and educate him on going online.

Liu Xu was worried for Lin Xiaobei.

"Just look at it." No need to explain, actions are the best proof.

"Mr. Lin!" Liu Xu hesitated to speak, but still obediently helped Lin Xiaobei put the old man in a standard side-lying position, with his back protruding like a bow.

Her basic skills are still very solid.

position.

Thinking of breaking the back of the model specimen with a light touch last night, although it was a bit exaggerated, Lin Xiaobei still had lingering fears afterwards.

It is reasonable to have strict system requirements, and there is no room for carelessness in clinical practice.

Lin Xiaobei carefully and gently touched the old man's spine, the dry bark-like skin felt a bit tingling.

He patiently counted up from the line of the anterior superior iliac spine, and marked it with a marker pen at T3-4; then he positioned it from above with the spinous process of the seventh cervical vertebra as a mark.

OK, the results of the two methods coincide perfectly, indicating that the positioning is accurate.

Disinfect, spread towels, and absorb local anesthetic.

When Lin Xiaobei pierced the thin waist needle 3cm above T4-2.5 which had already been positioned, Liu Xu's eyes widened incredulously again.

Usually, the ligamentum flavum is thickened and calcified in the elderly, and the puncture needle is not easy to break through to reach the epidural space. Experienced anesthesiologists will find another way to enter from the midline of the spinous process at a selected puncture point. The technical term is called "lateral approach".

However, almost all anesthesiologists will choose to insert the needle at a point 2-3cm below the spinous process, and I have never heard of or seen anyone who will start from the top.

Because it is easy to adjust the angle and orientation of the needle from bottom to top.

If you don't understand, just imagine that normal people's arms are bent upwards, and no one will twist them in the opposite direction unless affected by a disease.

"The anesthesia I received was not spinal anesthesia, but a new technology called paravertebral nerve block." Lin Xiaobei said calmly, dispelling Liu Xu's worries.

The prickly skin, subcutaneous fascia, muscle, transverse process, and the inclined needle tip continued to slide, accompanied by a familiar feeling of emptying, and the water drops in the syringe connected to the needle tail disappeared like being absorbed by a sponge.

Enter the intervertebral space smoothly!

Although in the secret room, Lin Xiaobei's operation is as unfamiliar as a novice who knows nothing, but in the real world, he is still a master of operation flow with ease and ease.

Just like the scumbags of QH and BD, they are still super-students in a certain technical school.

After injecting the local anesthetic, Lin Xiaobei followed the calabash to draw a scoop to perform a paravertebral block on the T6-7 intervertebral space.

Then the old man was given an intercostal nerve block.

"Okay, you can lie on your back now."

Liu Xu took a deep breath, and still asked unconfidently, "Mr. Lin, is this all right?"

This is a thoracic laparoscopic surgery, and the surgeon has high requirements for muscle relaxation.

This little local anesthetic can relieve pain, but it is unbelievable that the operation should be completed with this.

"No, I still want to insert a laryngeal mask for grandpa, give some FTN (intravenous analgesics) and adequate sedation, and keep breathing spontaneously." Lin Xiaobei whispered to her.

The laryngeal mask is a heart-shaped ventilation tool that does not need to enter the trachea, but can be inserted into the patient's mouth.Compared with endotracheal tubes, it is less irritating to the airway and can avoid damage to the throat and tracheal mucosa.

The operation of inserting the laryngeal mask is still done by catkins, and then QFM (an inhalational anesthetic) is activated.

"Director Yu, you can start." Lin Xiaobei directed.

The chest doctor was unaware of what Lin Xiaobei had done.

It doesn't matter, Lin Xiaobei is concerned about his target blocking effect.

When Chuka (a laparoscopic puncturer) pierced the chest wall, the grandfather remained motionless, and the monitor showed that his heart rate did not fluctuate significantly.

This shows that the blocking effect is very good.

When he was about to enter the thoracic cavity, Director Yu Zhendong reminded on the stage: "Dr. Lin, we require the patient to perform one-lung ventilation during the operation."

The so-called one-lung ventilation means that only the healthy lung is ventilated, and the sick lung is not ventilated.The lung on the affected side is in a collapsed and atrophied state due to lack of ventilation, which is conducive to intraoperative manipulation.

A double-lumen endotracheal tube has two openings at different locations, one for the left lung and one for the right lung.According to intraoperative needs, the left lung and the right lung were clamped with tracheal clamp to achieve one-lung ventilation.

However, Lin Xiaobei inserted a laryngeal mask for the patient, and still kept breathing spontaneously. It was impossible to perform one-lung ventilation.

"Director Yu, this old man's situation is very special. I didn't insert a double-lumen tube."

Yu Zhendong said in surprise: "You didn't insert a double-lumen tube?"

His assistant Wang Peng also forgot about Lin Xiaobei with a look of astonishment.

Thoracoscopic surgery requires complete collapse of the lung on the affected side. Lin Xiaobei is considered an experienced doctor, so it is impossible that he does not understand this basic common sense, right?
"Yes. Director Yu, this old man's sick side lung has mostly collapsed and atelectasis, and only a partial lobectomy is needed. I think you can use the lobe forceps to compress the lung to meet the surgical requirements. Try it, if it is true No, I'll re-insert the double-lumen tube." Lin Xiaobei said calmly.

Yu Zhendong was skeptical. After the light guide entered the chest cavity, he watched the video from the TV. As Lin Xiaobei said, the diseased lung did not need one-lung ventilation and had already collapsed. Although it would move with the movement of breathing, the effect was not significant. .

Wang Peng held the lobe forceps and pressed lightly, and the old man's diseased lung quickly shrank into a ball like a balloon that had been evacuated, which was better than the effect of single-lung ventilation.

"How is it, Director Yu?" Lin Xiaobei deliberately asked.

"Well, it's okay, I can make do with it for now." Yu Zhendong said reluctantly.

"Then let's do this first. You can tell me anytime you need to change the double-lumen tube." Lin Xiaobei said it very tactfully, and he had to give the surgeon face.

Yu Zhendong held the electrocoagulation hook in one hand and the separation forceps in the other, and the operation was very smooth.The video on the TV showed that the operation was going very smoothly. Lung pinching, separation, resection, hemostasis, titanium clips, suturing, the whole set of actions were done smoothly and smoothly.

"Give me a hemostatic gauze."

"Warm salt water."

Equipment nurse Liu Juan is methodical.

"Drum lungs!" Yu Zhendong forgot to glance at Lin Xiaobei after speaking.

The purpose of inflating the lung is twofold: to fully expand the affected lung and to check for air leakage from the surgical incision.If one-lung ventilation is used at this time, it is only necessary to block the healthy lung and ventilate the diseased lung.

But he did not insert a double-lumen tube, how to solve this problem?

Lin Xiaobei took his time, adjusted the pressure regulator of the anesthesia machine to the maximum 75 (fully closed, no air leakage), and gently and slowly pinched the ball.

"Stress 25."

The half of the salt water in the drainage bottle gurgled like a barbecue, turning into waves, then turned into bubbles, and finally subsided.

"Okay, that's it, no more swelling." Yu Zhendong looked at the remaining 1/3 of the diseased lung on TV, which was full and bright red at this time, in stark contrast to the black and smelly part of the tissue that was removed.

Who would have thought they were once a unit?
"Doctor Lin, you've put me to the test today." Yu Zhendong said to Lin Xiaobei before getting off the operating table.

"There, it's not that you, Director Yu, are highly skilled." Lin Xiaobei complimented quickly.

"Does the patient need to be sent to the ICU later?" He tentatively asked.

Just kidding, this patient hardly used any general anesthetics, and still kept breathing spontaneously, and the laryngeal mask could be removed in a while.

Lin Xiaobei still said very modestly: "I don't think it may be necessary."

Talk to yourself to leave a way out.

"It's best to go back to the ward." Yu Zhendong was disappointed that he didn't get an affirmative answer.But he didn't say much, and went out with a tray containing lung resections.

The rest of the finishing work such as suturing the incision is done by the assistant Wang Peng, which is also the only way for every surgeon to grow up.

"Doctor Wang, how long will it take you to finish the stitches?"

Wang Peng was still a resident doctor and had just graduated from graduate school, so he was a little shy, "20 minutes."

Lin Xiaobei frowned, such a small wound can be done in a few minutes.

"Maybe you don't do much work at ordinary times!" He thought, without saying anything, turned off the inhaled anesthetic, and ventilated with pure oxygen.

"Is the patient awake? He's moving!" Liu Juan saw the abnormality first.

"Well, it's okay, it won't affect Dr. Wang's operation." Lin Xiaobei used a sputum suction tube to wash away the secretions in the grandfather's mouth, and quietly removed the laryngeal mask.

"Fortunately, I will finish sewing soon." Wang Peng replied.

He is also a modest person. He said it took 20 minutes, and the application started in less than half the time.Like Lin Xiaobei, he likes to speak conservatively and leave room for it.

Withdrawing the towel, he forgot that the old man was stunned, "Mr. Lin, you, when did you remove the tracheal tube?"

He didn't know that the anesthesiologist inserted a laryngeal mask.

"Just now, grandpa has woken up, he can't stand the stimulation." Lin Xiaobei said lightly, winking playfully at Liu Xu, who was silly by the side.

"The muscle relaxation effect of your anesthesia is really good!" Wang Peng flattered.

"Really?" Liu Xu almost laughed out loud, and did not use any muscle relaxants during the whole process.

Lin Xiaobei glared at her, and said to Wang Peng, "The muscle relaxants are all given by catkin according to the calculated amount."

"Me?" The little girl looked confused.

"You are well prepared today, you deserve praise." He was afraid that she would slip up, so he quickly stopped her.

How shrewd Liu Xu was, she immediately came to her senses, glared at Lin Xiaobei, and stopped talking.

"Look, you offended your student again." Wang Peng said with a smile.

"She won't be so stingy. I can say she's fine casually, she—" before finishing speaking, Lin Xiaobei took a deep breath "hiss——".

Liu Xu suddenly stretched out her small claws and grabbed his arm hard, like pincers.

Seeing this, Wang Peng smiled meaningfully.

"Doctor Lin, even the little girl feels offended, you really don't know how to live or die."

……

While chatting with each other happily, Li Jufang, the itinerant nurse who had been silent all the time, suddenly exclaimed.

　Thank you to those who voted for, thank you for your continued support!
　　Thanks to "2020***3185", a book friend, for the reward of 100 starting coins.It was the first time I received such a reward, and I was very touched.I wish you good health, all the best, and a lot of money, and you can continue to support me in the future. ^_^
　　
　
(End of this chapter)