Back to 1999: From operating surgeon to becoming a top doctor

The hypercapnia and high airway pressure mentioned by Xiao Chenguang are only the most common problems in anesthesia management for laparoscopic surgery.

As for other more complicated problems such as renal perfusion and decreased cardiac output, Xiao Chenguang did not mention them because this surgery was not involved for the time being.

But at this moment, Liu Tie was so shocked that he could not speak.

Unlike the instrument nurse who seemed to be listening to a book of heaven, this was his profession, and he could naturally distinguish whether Xiao Chenguang was talking nonsense or had real skills.

Even through Xiao Chenguang's concise explanation, Liu Tie felt a sense of sudden enlightenment.

This was a feeling he had never had when he went to the provincial capital for further studies.

"Doctor Xiao, how should the patient's respiratory parameters be set?"

Liu Tie asked respectfully with a humble expression.

As soon as this was said, it was Wang Jingang's turn to be surprised.

He knew that Xiao Chenguang was very powerful, but he didn't know that he was so powerful.

In Wang Jingang's view, Liu Tie was already the mainstay of the Anesthesia Department of Shengli Hospital, and his knowledge reserves and clinical experience were no worse than their department director.

That's why he had to lower his face and let Liu Tie come from home to follow the stage at night.

But now.

He was actually respectfully asking Xiao Chenguang questions.

There was even a hint of humility in his attitude.

"In fact, the parameter setting is very simple."

Seeing Liu Tie's correct attitude, Xiao Chenguang simply said: "First, calculate the tidal volume according to the patient's height and weight, then set the inspiratory pressure and positive end-expiratory pressure according to the strategy of lung protective ventilation, and finally adjust the respiratory rate through arterial blood gas analysis."

"Like the old man on the stage, due to a huge incisional hernia, the abdominal pressure is greater than that of a normal person. You can adjust the PC to 15cmH20, peep 5cmH20, inspiratory-expiratory ratio 1:2, and respiratory rate 20 times/minute."

Xiao Chenguang even explained to Liu Tie clearly the values ​​that are not often touched, such as pressure rise time and trigger sensitivity.

Now, Liu Tie was completely convinced.

Many things that he had been confused about before, now after Xiao Chenguang's explanation, it seems to have opened a brand new door for him.

Liu Tie nodded his head in the face of the vast knowledge like a chick pecking at rice.

This made the nurse on the instrument table very happy.

She had been working with Liu Tie for so long, and when had she seen him so serious and eager to learn?

Doctor Xiao was really strong.

The worries that had originally shrouded their hearts disappeared without a trace at this moment.

"Xiao Xiao, the equipment has been installed, and the operation can be performed." Wang Jingang pushed the debugged laparoscopic imaging system to the side of the table.

"Okay, Director." Xiao Chenguang nodded with a natural expression.

Eh?

The instrument nurse looked at the two of them in a daze, always feeling that something was wrong.

But she couldn't tell what was wrong.

Then the two washed their hands, put on surgical gowns, and stood on the operating table together.

Now the instrument nurse finally found out what was wrong.

"Director... Doctor Xiao, are you two standing in the wrong position?"

Eh?

The two were startled at the same time, instinctively looked down, and suddenly became embarrassed.

In the operating room, Xiao Chenguang stood in the position of the main surgeon, while Wang Jingang stood in the position of the assistant.

The most important thing is that neither of them noticed it.

"That..." Wang Jingang's face was a little red. Even though he had been working for many years, he didn't know what to say at this moment.

"The standing position of laparoscopic surgery is different from that of traditional surgery." Xiao Chenguang said seriously.

"......" Wang Jingang.

"???" Liu Tie.

"Oh, oh, sorry, this is my first laparoscopic surgery, I'm so sorry, I didn't know." The instrument nurse looked flustered and apologized quickly.

"......"

......

"Xiao Xiao, how about it?"

"Director, let me hold the mirror."

Xiao Chenguang knew what Wang Jingang wanted to say, but he couldn't be the main surgeon until the surgery permission was raised.

Besides, in laparoscopic surgery, sometimes holding the mirror is more important than being the main surgeon.

"Okay, I got it."

Wang Jingang was very conflicted. He knew Xiao Chenguang's strength, but this damn permission...

Wang Jingang had already made a secret decision. After this operation was completed, he would go to the hospital to apply for the permission for the operation.

At that time, even if he had to slam the desk of the hospital leader, he would let Xiao Chenguang's permission for the operation be upgraded to level four.

Wang Jingang even began to consider Xiao Chenguang leading a team.

Although he was young, he had good skills. With Xiao Chenguang's ability, it might be a bit unfair for him to be a deputy director.

It's just that Wang Jingang's permission right now is only that of a department director, but if he could become the director of general surgery...

"Director, the patient's skin has been disinfected."

Xiao Chenguang wore surgical gloves and wiped the patient's entire abdomen with iodine gauze according to the standard.

The range was from the xiphoid process to the upper 1/3 of the thigh, and from both sides to the posterior axillary line. After three disinfections in sequence, the range gradually narrowed.

The patient's originally fair skin gradually turned dark brown, and it felt like paint was painted on the skin.

"Okay, prepare to establish pneumoperitoneum."

Wang Jingang's thoughts returned to reality. As the scalpel was handed over, he began to make a 10mm skin incision at the lower edge of the umbilicus.

He then used his index finger to penetrate the incision and began blunt separation, and soon the milky white peritoneum layer was revealed.

To be honest, for Wang Jingang, no matter how good the separator was, it could not beat his own fingers.

This is the most common technique used by the older generation of surgeons. After all, when they were young, the conditions were difficult and there were no surgical instruments like today.

Over time, they got used to using their fingers to "knead the meat".

Xiao Chenguang watched the director skillfully dig and dig in the small incision of the patient with his fingers, and shook his head helplessly.

Rough, really too rough.

If this had been put in 20 years, he would have been scolded by his superiors.

But now it is 1999, and everything is so logical.

"The director is worthy of having studied laparoscopic surgery. The selection and freeing of the incision are very skilled."

Xiao Chenguang praised himself in a self-consoling way.

"Really? Although I don't do much laparoscopic surgery, I have been practicing with various substitutes in the operating room during that time."

Wang Jingang, who was in surgery, heard it and seemed very happy.

It seemed that Xiao Chenguang's casual praise was a recognition of him.

Xiao Chenguang: "..."

But the good times didn't last long. When Wang Jingang was about to insert the pneumoperitoneum needle from the incision, he found that the patient's peritoneum was pushed out by the swollen intestinal tube.

The space left for him to puncture was very small. If he was not careful, he would puncture the intestinal wall and cause intestinal perforation.

Looking at the thin peritoneum and the intestinal tube that was about to come out, Wang Jingang's hands trembled a little.

While he was hesitating, Xiao Chenguang's voice came at the right time.

"Director, how about I do it?"

"Okay."

Wang Jingang felt relieved and handed the pneumoperitoneum needle to Xiao Chenguang opposite.

Although Wang Jingang had also inserted a peritoneal drainage tube, the process of the two was similar, but the pneumoperitoneum needle was thick and large, and he was a little uncontrollable.

"It's quite handy."

Xiao Chenguang took the pneumoperitoneum needle and weighed it. Although the material was still different from the future, he could still feel the sharpness of the metal needle tip when holding it in his palm.

He took a look at the peritoneal incision, tilted the pneumoperitoneum needle in his hand, and stabbed it at a 45-degree angle to the abdominal wall without any hesitation.

The long pneumoperitoneum needle was shortened by half in an instant, which made Wang Jingang's eyelids jump.

Xiao Chenguang was really bold.

At this angle and depth, if he was not absolutely confident, he might have penetrated the intestines with one needle.

But at this time, Xiao Chenguang was calm as water, and his operation speed did not slow down, and even became faster and faster.

He pulled back the pneumoperitoneum needle core to ensure that the needle tip did not enter the blood vessel by mistake. Then he asked for saline solution and connected it to the pneumoperitoneum needle. The saline solution in his hand flowed into the abdominal cavity.

"The puncture was successful, and the carbon dioxide inflator was connected to the pressurization to establish artificial pneumoperitoneum."

"The air intake rate of the pneumoperitoneum machine is 0.5L/min, and the total volume is 2L. The intra-abdominal pressure is set to 12mmHg, and the total pressure does not exceed 2.13KPa."

Xiao Chenguang said calmly.

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