super anesthesiologist

Chapter 42 I Listen to You (Come on!!!)

"Is that so? That's okay too!" He was dubious.

In fact, what Hu Wenmao cared about was not Lin Xiaobei's method of anesthesia, he only asked the patient to wake up and return to the ward after the operation.

The reason why he is very disgusted with general anesthesia is because Wang Yuansheng is likely to be sent to the ICU after surgery.Now that Lin Xiaobei is boasting about going to Haikou, he can relax.

"Director Hu, what is your operation method today?" Lin Xiaobei asked.

"Let's look at the specific situation first."

For choledocholithiasis, there is now a technique called "endoscopic retrograde cholangiopancreatography (ERCP)". The choledochoscope is inserted into the bile duct to find the location of stone obstruction through contrast medium development, and then the obstruction problem can be resolved through choledochoscope removal of stones or placement of stents .

This kind of operation does not require surgery, the surgical trauma is small, and the postoperative recovery is fast.

But things always have two sides. ERCP has huge advantages, but of course it also has obvious disadvantages.First of all, this technique will increase the incidence of pancreatitis. In addition, because it is an extracorporeal operation, there are many restrictions on the location and size of the stones. The third point is that the patient has liver and kidney dysfunction, which is a contraindication.

This is why Director Hu Wenmao did not implement ERCP for Wang Yuansheng.

If Lin Xiaobei's prediction is not wrong, Hu Wenmao definitely wants to perform "common bile duct stone removal + T-tube drainage".

This is a relatively old-fashioned surgical method. Because it requires an open abdomen, the trauma is much greater than that of ERCP.However, this surgical treatment is more thorough because it is performed under direct vision.

And due to the application of hemostatic gauze and ultrasonic scalpel, the trauma is much smaller than before.

Hu Wenmao and Zheng Quan came to the stage after washing their hands, disinfected and positioned them. The surgical incision site was similar to Lin Xiaobei's prediction: about 2cm to the right of the xiphoid process.

"Turn the electric knife to 55." He said to Qiu Hong after the skin was cut.

The ECG monitor immediately heard a sharp alarm sound, and the normal ECG turned into chaotic wavy lines in an instant.

"Director Hu, let's adjust it to 40 first. You will disturb the patient too much if you adjust it so high. If you read the electrocardiogram, you will call the police." Lin Xiaobei suggested.

"Then adjust it to 40 first." Hu Wenmao was very obedient, but he frowned secretly after a while.

The skin fibrosis of the elderly is not as elastic as that of young people. It is very laborious to burn the electric knife. If it is turned down, it will not burn. If it is turned up, it will not only interfere with the patient's electrocardiographic activity, but also easily cause incision burns and affect postoperative recovery. .

Lin Xiaobei pretended not to know the details and secretly observed that the effects of ganglion block and local target injection are currently very good.In the absence of deep anesthesia, no matter whether it is skin incision or electric knife cauterization, the patient's skin and muscles did not vibrate or contract.

"I'm going to eat."

"Yes, I see." Lin Xiaobei adjusted the number seven to three.

"The viscera of the abdominal cavity are not sensitive to cutting, but they are particularly sensitive to the stimulation of temperature and stretching." He explained to Liu the reason for deepening anesthesia at this time.

The abdominal organ receptors are different from those of the peripheral skin, muscles, and bones. It does not hurt when you cut with a knife, but it is often very uncomfortable for patients to pull their intestines or omentum.

Stomach pain is often described as "cramping," which is the uncomfortable feeling of being entangled in something, rather than the sharp pain of being hit by a rock.

RB people once had the "feat" of committing seppuku suicide, but it was actually not as painful as imagined.Because those people didn't die from pain, but from bleeding and shock.What is really painful is the ancient criminal law "lingchi" and "peeling", which are painful to death.

"Don't you need muscle relaxants?" Liu Xu asked in a low voice.

From the skin incision to the current use of 10mg rothium ammonium, she really has no idea.

"Shh!" Lin Xiaobei made a silence gesture.

The anesthetist does not take the initiative to add medicine, and the surgeon does not know, but they often blame others when they encounter difficulties during the operation.

For example, the electric knife is not easy to use;
For example, the shadowless lamp is not good at seeing the light;

For example, the scissors are too blunt;

……

And for anesthesiologists, their favorite mantra is: "Muscles are too tight and not relaxed enough."

The weirdest thing is that some surgeries obviously don’t require strong muscle relaxation, such as hernia repair, and some doctors also like to complain.

Lin Xiaobei also knew that the effect of the muscle relaxant was almost up, but he just didn't add it.Because he implemented compound anesthesia (several anesthesia methods used at the same time) for the patient, he did not need to rely on roxime ammonium to increase muscle relaxation.

Moreover, the drug metabolism of the elderly is slow and cannot be calculated according to the normal time.

Last night, I trained in the secret room provided by the system for nearly 2 hours, and completed the precise target injection and ganglion block of nearly 500 specimens. The pass rate reached 30%. The result of the comprehensive evaluation is entry.

With the requirements of the system, this is very rare, so Lin Xiaobei is full of confidence.

Hu Wenmao did not complain about the lack of muscle relaxation. From the degree to which he and Zheng Quan used the gag to expand, it can be seen that they are very satisfied with the degree of muscle relaxation.

There is no problem with muscle relaxation, but Hu Wenmao's operation is not smooth.

"Director Hu, stop!" Lin Xiaobei stopped urgently.

The patient's heart rate suddenly dropped to 42 beats per minute.

The vagus nerve is densely distributed on the surface of the abdominal viscera, and it is easy to cause vagal reflex after being stimulated, leading to sinus bradycardia, and severe cases may cause cardiac arrest.

Lin Xiaobei deliberately injected a little local anesthetic near the vagus nerve when the ganglion was blocked.

The sudden drop in Wang Yuansheng's heart rate was not due to contact stimulation, but Hu Wenmao's stretching caused a distant vagal reflex, commonly known as "stretch reflex."

Fortunately, Lin Xiaobei had sufficiently sedated the patient, otherwise he would have been very uncomfortable.

After Hu Wenmao paused, the patient's heart rate slowly rose to 56 beats/min.

"Give me 0.2mg of opiates." Lin Xiaobei instructed Liuxu, and he picked up "MH base" and dripped 3mg from Murphy's test tube.

This is his "unique skill", which is very effective in dealing with sinus bradycardia. Wang Yuansheng's heart rate instantly increased to 75 beats per minute.

"Director Hu, don't pull too hard, the patient is very sensitive."

"Yeah. I know."

Hu Wenmao said this, but just a few minutes after the start, Wang Yuansheng's heart rate dropped from over 70 to over 40.

"Director Hu!" Lin Xiaobei reminded, "Don't pull it."

"Director Hu!"

……

"If I don't pull the choledochoscope, what do you think about the surgery?" Hu Wenmao was a little impatient after being called to stop several times.

"Tell me before you pull."

"it is good."

Although a verbal agreement was reached, during the operation Hu Wenmao was engrossed in his intraoperative vision and did not pay attention to Lin Xiaobei.

"Director Hu, the patient's heart rate is slow again."

Hu Wenmao did not hear the detailed installation, and was still operating on the stage.

Wang Yuansheng's heart rate instantly dropped to 25 beats per minute!
A heart beat less than 30 beats is functionally equivalent to a cardiac arrest, and if it is not dealt with in time, it will soon form a straight line.

"Stop! Stop! Stop!" Lin Xiaobei almost ordered.

"Director Hu, the patient's heartbeat is almost gone."

This time Hu Wenmao also panicked, and stammered and asked, "Why, how is it possible?"

"Look, how is it possible!" Lin Xiaobei roared, and quickly stopped the inhaled anesthetic and pumped acetaminophen.

Hu Wenmao looked at the monitor, his face pale.Zheng Quan was almost trembling on stage.

At this time, the effect of the drug is very poor. After pushing one, the heart rate hardly responds, and it is still more than 20 times.

"Liuxu, get an adrenaline shot."

Lin Xiaobei walked to the front of the stage, lifted the drape to protect the operation area, and began to press on the apex of Wang Yuansheng's heart to perform cardiopulmonary resuscitation.

"Ms. Lin, the adrenaline is ready." Liu Xu was flustered inside, but tried to stay calm on the surface.

"Push directly."

"Teacher Qiu Hong, help me move the defibrillator, it's in the PACU room."

After the adrenaline was pushed down, Wang Yuansheng's heart rate finally rose to 120 beats per minute.

But, along with atrial fibrillation also came.

Lin Xiaobei took another dose of atropine and 10 mg of MHJ. The atrial fibrillation disappeared and the heart rate jumped to 150 beats/min, accompanied by ventricular tachycardia.

"Ri**in 100mg net push."

"Ms. Lin, the defibrillator is here." Qiu Hong hurried in pushing the ambulance.

"Thank you, put it aside for now."

I was worried about ventricular fibrillation just now, but now the heart rate is slowly returning to normal, and I will observe it for a few minutes.

"Doctor Lin, are you all right now?" Hu Wenmao asked tremblingly.

"It's been slowed down for a while, but don't do the surgery right away, wait for him to stabilize."

"Okay, I'll listen to you."

Lin Xiaobei suggested: "You can extend the incision appropriately."

Now there is a misunderstanding that the smaller the surgical incision, the higher the level.In fact, it is not the case. Although a small surgical incision is conducive to rapid postoperative recovery, but too small a surgical field affects the operation, and sometimes it is counterproductive.

Director Hu Wenmao is in this kind of predicament now.Because the incision was too small, and the upper abdomen was not as good as the lower abdomen, the extensibility of the chest muscles was poor, and the incision was deep, so there was no room for him to operate when he put the choledochoscope in.

Under normal circumstances, two fingers need to be inserted to support the light guide so that the front end of the mirror can slide forward smoothly.

It was precisely because the mirror was stuck and there was no room for adjustment that Hu Wenmao kept pulling it, which caused a strong vagal reflex.

"This?" He was still hesitating.He thought it wasn't that the incision was too small, but that his and Zheng Quan's hands were too big.

Lin Xiaobei further advised: "It's the same as giving the patient a fine suture at the end of the operation."

"What if the tension is too great?"

Hu Wenmao's scruples are very reasonable. The upper abdominal surgical incision generally requires thick sutures, because the postoperative tension is very high, and the wound is easy to burst.

"I'll bury a subcutaneous analgesic pump for the patient, so there won't be a lot of tension." Lin Xiaobei replied.

"That's good. Well, pass me the blade and the hemostat." Hu Wenmao said to the nurse Ye Hui on the stage. After careful consideration, he still felt that what Lin Xiaobei said made sense.

The larger the incision is, the more convenient it is to operate, and the choledochoscope can be easily slid in.

Now that the patient's condition is stable, Hu Wenmao did it with ease, and suddenly asked: "Doctor Lin, how much muscle relaxant did you give?"

　There are still 30 favorites to break through the 300 mark. Whether it is on the street or not, I think it is an inspiring thing.

　　The idiot is very excited, but also working very hard, striving to make a breakthrough.

　　I hope you guys will continue to support us.

　　I wish you all good health, good luck and happiness! ! !
　　
　
(End of this chapter)