super anesthesiologist

Chapter 54 Exquisite Appendectomy (Please recommend, please collect, bow!!!)

Lin Xiaobei didn't even know the specific condition of the patient, so it was impossible for Lin Xiaobei to listen to him.

The outpatient medical records showed that the patient Li Dingguo suffered from right lower abdominal pain for half a day... and the final diagnosis was "acute appendicitis".

"Xu Dingguo, what's wrong with you?"

"Stomachache."

"Stomach pain" is too general a concept. Medically, there are countless reasons that can cause stomach pain. There are organic organ lesions, inflammatory reactions, referred pain, and neurogenic pain...

What's even more bizarre is that with the changes in the lifestyle and rhythm of modern people, a kind of "conscious pain" has also appeared.This kind of pain has no disease basis, and the patient's physical examination shows nothing abnormal.

But the patient himself complained of body pain, and the pain was always limited to a certain place, and it was more common in the lower abdomen.

Diagnosing this disease is often a headache. The doctor diagnoses the patient's health based on the results of the examination, but the patient himself concludes that he is susceptible to the disease, and sometimes exaggerates the pain.

An effective diagnostic method to treat such patients is to use some sedatives, and everything will behave as ordinary people after calming down.

Lin Xiaobei carefully examined the patient just to diagnose exactly what kind of condition he belonged to.

"Why does your stomach hurt?"

"When did the pain start?"

"Have you had any other illnesses before?"

……

After a series of inquiries, other lesions were basically ruled out. During the physical examination, the patient's abdominal tenderness points were very clear, and the painful area was also very limited.

It is acute appendicitis.

Lin Xiaobei is ready.

Director Li Aiguo's work efficiency is still very high. He basically adopted the suggestions made in the afternoon, and even made a copy of the informed consent form for outpatient surgery in the anesthesiology department.

After fully communicating with the patient, Lin Xiaobei began to anesthetize the patient.

"Doctor Lin, you don't need to pose?" Xu Zhenzhen asked in surprise.During her study in the Department of Anesthesiology, she was mainly on the instrument table for appendicitis, and she is also very familiar with the anesthesia method for this operation.

Now with the popularization of laparoscopic technology, Director He Ran of Anorectal Department performs most of their appendicitis operations under laparoscopy.

The anesthesia for this type of surgery is general anesthesia, but there are some special patients who are not suitable for laparoscopy, so traditional epidural anesthesia is used.

It is impossible to use laparoscopy for appendicitis in the emergency department, but general anesthesia for laparotomy is a bit...

What's more, Lin Xiaobei didn't have any general anesthetics prepared.

What does he mean by disinfecting directly on the patient?Is it local anesthesia?
Local anesthesia for appendicitis is no better than other debridement operations, and the stretch reflex is uncomfortable.When she was studying in the operating room, she encountered a case where the epidural anesthesia did not work well and was changed to local anesthesia.

Xu Zhenzhen couldn't bear Lin Xiaobei's embarrassment in the emergency department, secretly worried for him, and asked him if he needed to put himself in a position as a secret reminder.

"No need." Lin Xiaobei was as calm as water, looking confident.

Xu Zhenzhen couldn't talk much, so she had to cooperate with him silently, pouring disinfectant and delivering local anesthetic.

Lin Xiaobei chose several injection points in Xu Dingguo's lower right abdomen, and soon after each injection, he used sterile gauze to gently press on the Pichu to make the local anesthetic spread better.

"Li Dingguo, how do you feel now?" He asked.

"Much better, but still a bit."

Patients are always like this, fearful of pain.

Lin Xiaobei gently pressed Li Dingguo's Mai's point with his fingers, and then suddenly relaxed, he didn't even frown.

"Okay, you guys are going to operate." While talking to Bian Wengang and Xu Zhenzhen, he gave the patient 2mg of militone and 5ug of SF from Murphy's test tube.

At this moment, Director Li Aiguo walked in, "How is it? Dr. Lin?"

"it should be no problem."

"Well, you go to the next room and anesthetize my patient, he also has appendicitis."

What's the matter, they came together on the first day of opening, and the girl lying outside was also diagnosed as appendicitis.

Director Li Aiguo's patient is an old man, and his situation is far more complicated than that of Li Dingguo. Moreover, he has symptoms of peritonitis, and he may have perforated appendix gangrene.

Because it was night, only Lu Feng was on duty, so both Li Aiguo and Bian Wengang were in charge of one operation without an assistant.

There are no itinerant nurses, and there is only Xu Zhenzhen as the equipment nurse, who is assigned to Bian Wengang.Director Li Aiguo is a polished commander.

Lin Xiaobei quickly anesthetized the patient, and after trying it, the effect was also very good, and there was no problem at all to meet the needs of the operation.

Because the condition of the patients here is worse, Lin Xiaobei ordered Xu Zhenzhen to help check Li Dingguo's vital signs, and then guarded the old man, Xu Jiasheng.

"Doctor Lin, put on your gloves and help me." Li Aiguo said, he was a bit overwhelmed with finding instruments and fixing retractors when the surgical field was exposed.

Lin Xiaobei then played the roles of surgical assistant, instrument nurse, and anesthesiologist at the same time.

Director Li Aiguo is worthy of being a former anorectal expert. Compared with the unfamiliar man who does manual debridement during the day, his skills in appendicitis surgery are nothing to say, and his movements are smooth and flowing.

As soon as the experts make a move, they will know if there is any.

The surgical incision he made on the patient was very small, about 2cm, only big enough for a finger.

"I'm going into the abdominal cavity." He reminded.

This is a good habit of coordination and communication between surgeon and anesthesiologist.

The abdominal cavity is different from the subcutaneous muscular fascia layer. There are usually nerves on the surface of the abdominal viscera. A little stretching will cause obvious fluctuations in the patient's vital signs, especially the heart rate. The change is very obvious.

The elderly are prone to severe sinus bradycardia, which can lead to cardiac arrest if not treated in time.This is why Lin Xiaobei focused on the anesthesia here.

"Got it, I'm watching." Lin Xiaobei replied.

Li Aiguo gently lifted it up with the hook, and handed it to Lin Xiaobei to help him hold it.This way he can free up one hand.

He inserted his little finger through the center of the incision, probing the abdominal cavity.

This is a signature move of veteran surgeons.Lin Xiaobei knew that he was looking for the appendix, and as an anesthesiologist, his main task at this moment was to closely observe the changes in vital signs on the monitor.

Because it is a blind investigation, the movements cannot be precise, and it is inevitable that the internal organs of the intestinal cavity will be affected.This time is the most critical period for arrhythmia.

Director Li Aiguo frowned, Lin Xiaobei thought he hadn't found his appendix yet, and was thinking about how to comfort him not to rush and take his time.

But he slowly pulled out his fingers, and the end of his fingertips curled up, clamping a section of bright red, congested intestines as thick as a little finger.

He hooked out the appendix directly!
"Director Li, you're really good!" Lin Xiaobei admired.

His action is like a master catching an eel, sticking a finger in, he can catch the eel out without destroying the mud hole.

It seems simple, but it cannot be done without hard work.

Li Aiguo chuckled, "I'm old, otherwise I wouldn't have worked so hard."

Although his movements are very skillful, his concept is still a bit old-fashioned.

First clamp the appendix with intestinal forceps, and deal with the mesentery at the root of the appendix, which is the most critical part of appendectomy.

Director Li Aiguo also slowed down at this time, clamped the tip of the appendix with pliers with one hand, and carefully fiddled with the root with tweezers with the other hand to check for inflammation, edema, and bleeding.

Because the method of appendectomy is different in different states.

Another point is to be very careful at this time, because the appendix artery is nearby.In the past, in order to prevent arterial rupture and bleeding, the mesappendix and arterial ligation were usually removed first.

Now, due to the surgical electrosurgical knife and hemostatic gauze, which can stop the bleeding in time, few doctors do that. They always check the local anatomy before deciding on the next operation method.

Director Li Aiguo is still used to the previous operation method, first ligate the appendix artery and mesentery, and then remove it with one knife, the action is crisp and neat.

After the mesoappendix is ​​dealt with, the next step is purse-string embedding suture.At this time, an assistant is usually needed to help pull the hook and pull the thread, but Li Aiguo can handle it by himself, holding the tweezers in his left hand and the needle in his right, calmly.

Just like others watching Lin Xiaobei doing anesthesia-related operations are pleasing to the eye, Lin Xiaobei also enjoys watching Director Li Aiguo holding needles and sutures.

Purse string suture is a very delicate step in appendix surgery.It is required that the stitches should not be too deep or too shallow. If it is too deep, it will stray into the intestinal cavity and cause infection.

Director Li Aiguo sews very delicately, the needles are evenly spaced, and there are no creases between the stitches.After a round, I want to wear a flowing wig for my appendix.

Lin Xiaobei secretly marveled at the details, and suddenly heard a scream from the patient in the operating room next door, "Oops!"

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(End of this chapter)