roccoschili Page 518
Page 518
Director Zou, the anesthesiologist and Deng Ming were all stunned.
Especially Director Zou and Deng Ming, they both thought that Zhou Congwen saw that his boss's expression was wrong, so they changed the subject.
Unexpectedly, Zhou Congwen came over as soon as he opened his mouth, and blurted out the reason for the patient's blood oxygen drop.
Is that the case?
The eyes of the two looked at Huang Lao at the same time.
Huang Lao looked at Zhou Congwen expressionlessly, and there was nothing unusual on his face.
"Again, patients with giant tracheobronchial disease cannot be intubated as usual." Zhou Congwen said after flipping through the record sheet and quickly flipping through the medical records.
The anesthesiologist was surprised. With the speed of browsing, there were ghost images in front of his eyes. What could Zhou Congwen see?
"Boss, the anesthesia is okay. After entering the room, give midazolam 2mg, sufentanil 30μg, etomidate 16mg, and cisatracurium 15mg."
Huang Lao nodded slightly.
"I am going to use bronchofiberscope to guide and insert a reinforced endotracheal tube with a lower inner diameter of 8.0 mm into the right main bronchus for one-lung ventilation."
"What should I pay attention to before going down?" Elder Huang asked with his hands behind his back.
"In order to prevent the front end of the catheter from blocking the opening of the bronchus in the right upper lung, I want to cut off the front end of the catheter. Before that, I will look at the right main bronchus and trim it according to the patient's physiological and anatomical shape."
Old Huang's eyes narrowed.
Director Zou was taken aback.
Is this a custom cannula?
Something like that happens very, very rarely, very rarely.
Because the endotracheal intubation used in the anesthesiology department is standard, although there are many models, the anesthesiologist should judge according to the patient's condition, and then choose the type of endotracheal intubation, but there is basically no preoperative trimming method.
What is Zhou Congwen talking about?
He was a little suspicious, and looked at Huang Lao.
"I also take a look at the right main bronchus with the bronchoscope." Huang Lao said.
"Okay!" Zhou Congwen immediately called the anesthetist to prepare the bronchoscope.
The fiberoptic bronchoscope seemed to have been endowed with a soul in Zhou Congwen's hands, as if it had come alive, and he went in without seeing any special movements from him.
"The maximum diameter of the trachea is 40.2mm, the maximum diameter of the right main bronchus is 30.5mm, and the maximum diameter of the left main bronchus is 28.7mm." Zhou Congwen raised his head and reported to his boss after measuring with a fiberoptic bronchoscope.
Huang Lao was noncommittal, tapped the back of his left hand lightly with his right hand behind his back, and leaned over to take a look.
"The left and right main bronchi were dilated in the lumen of the trachea, and the lobes and segmental bronchi were dilated, forming a diverticulum. There was purulent secretions in the left lower lung bronchus, and there was a bulge at the opening of the right upper lung bronchus, which was blue-purple. Hemangioma was considered possible."
After listening to Zhou Congwen's report, Mr. Huang nodded after confirming himself again.
Zhou Congwen took the 8.0mm endotracheal tube from the anesthesiologist, asked for a pair of scissors and began to trim the front end of the endotracheal tube.
He cut off about 2.3cm, trimmed it, and handed it to Mr. Huang after it was free of spikes.
"Boss, take a look."
"Okay, let's go." Huang Lao was very satisfied with Zhou Congwen's operation.
Director Zou paid attention to Zhou Congwen's every move, and he seemed to understand the meaning of cutting off the 2.3cm endotracheal tube, just like what Zhou Congwen and Huang Lao reported, it was to prevent the front end of the tube from blocking the opening of the right upper lung bronchus.
Zhou Congwen inserted the endotracheal tube, put it in 29cm, injected 30ml of air into the cuff, and asked for iodoform gauze to stuff the glottis.
一切做好后，周从文道，“丙泊酚0.06~0.1mg·kg-1·min-1、瑞芬太尼0.15~0.25μg·kg-1·min-1、顺式阿曲库铵1.5~2μg·kg-1·min-1，维持BIS50~60。”
After speaking, he glanced at Huang Lao and started to operate.
With one-lung ventilation, the patient's blood oxygen saturation did not drop this time, so it looks like it should be done.
"Okay, let's do it." Huang Lao said lightly.
After Zhou Congwen finished all the preparations, he said to the anesthetist, "Use the stool."
After finishing speaking, he lifted the stool into the corner with his back, "Boss, take a break."
Director Zou couldn't say a word after reading it.
No matter what kind of giant tracheobronchia, what kind of sophisticated anesthesia methods, they can't compare with Zhou Congwen's flattering skills.
After finishing the anesthesia, Zhou Congwen didn't waste a single extra movement. The first thing he did was to move the stool for Mr. Huang.
Gee.
Chapter 0892
Huang Lao sat in the corner, looking at Zhou Congwen very satisfied.
"Zhou Congwen, you did a good job."
"With you here, I have confidence in my heart." Zhou Congwen replied with a smile.
Director Zou smiled wryly while looking at the values on the monitor and ventilator.
He knew very well what Huang Lao was like, and general flattery would not work with Huang Lao.
What hasn't Mr. Huang seen?People eat more salt than these young people eat. Their life has been turbulent and magnificent, with ups and downs. They have seen countless lives and deaths.
But Zhou Congwen was different. He seemed to put all his attention on Mr. Huang, doing every detail perfectly, as if performing a difficult operation.
Water drips through stones, and ropes cut wood. If I had such a student by my side, I would probably be very happy.
Director Zou looked at Zhou Congwen with complicated eyes.
"Tell me." Huang Lao said lightly after sitting down.
"The patient I met before was not undergoing thoracic surgery." Zhou Congwen bent slightly, and said softly beside Mr. Huang, "The patient was undergoing cholecystitis surgery. As a result, there was a problem with the anesthesia, so I thought about it more. "
"Ah? Gallbladder removed?" Director Zou was startled.
Zhou Congwen continued, "At that time, the general anesthesia was changed to a continuous epidural. The position was relatively high, and the operation was completed. I wondered what to do if I encountered chest surgery, so I gained a little experience."
"Tell me in detail." Elder Huang also became interested and asked lightly.
"CT examination is the gold standard for the diagnosis of giant tracheobronchitis.
For patients with giant tracheobronchia, lower abdominal surgery or lower extremity surgery should be performed under regional anesthesia, and continuous epidural anesthesia is also acceptable.
Patients with giant tracheobronchia who must be anesthetized can use CT to measure the diameter of the trachea and main bronchi to formulate a detailed airway management plan and select appropriate airway management tools. "
"But the risks are higher."
Zhou Congwen added a sentence.
"Why?" Director Zou asked.
"Macrotracheobronchia is characterized by marked dilation of the tracheobronchi, tracheobronchiomalacia, and diverticulum formation, accompanied by recurrent lower respiratory tract infections."
"I saw a similar report in an issue of The Lancet. The operator used a bronchial obstruction catheter. Zhou Congwen, what do you think?" Mr. Huang continued to test Zhou Congwen.
"I don't think it's right for him to do this." Zhou Congwen replied frankly.
Director Zou was dumbfounded.
"The Lancet", the world's top journal, is judged by Huang Lao, a big name in the industry.
Documents that can be published in The Lancet must be carefully selected to ensure that there are no logical problems and that they are feasible.
But Zhou Congwen denied "The Lancet" in one sentence!
"Bronchoblocking catheters are generally difficult to block the bronchi, and it is also difficult to collapse the lungs due to a large amount of secretion blockage. If the operator uses a bronchial blocking catheter for surgery, I guess it is a case-by-case analysis, and there is no large-scale sample. If you do If there are too many, the author will find that it is impossible to do so, and something will definitely happen.”
"Well, not bad." Mr. Huang gave Zhou Congwen an affirmative answer, "Then how should the patient be treated after surgery."
"Postoperative complications of patients with giant tracheobronchial syndrome include difficulty in expulsion of sputum, airway collapse, and stenosis. Apply continuous positive airway pressure to prevent bronchial collapse."
"Extubation of patients with giant tracheobronchial disease should be performed after the patient is fully awake, muscle tone is fully restored, arterial blood gas analysis is normal, and the patient is ready for re-intubation before extubation."
Seeing that the boss was silent, Zhou Congwen added after pondering, "One more thing, it is best not to use opioids for postoperative pain relief."
Huang Lao didn't show a faint smile until this time, "Almost, that's it, Xiao Zou will remember it."
"..." Director Zou's heart sank. Although he knew that Mr. Huang would not test himself, what if.
"I've seen it once, and I'll remember it in the future." Huang Lao said, "If you meet a similar patient again, don't make such a fuss. At my age, I may not be able to stay with you for long. Next time I meet you, I don't care." It's two talking."
"Yes, Mr. Huang." Director Zou said quickly, "By the way, Mr. Huang, I want to study this disease. What books should I read?"
"It's not in the book." Huang Lao shook his head, "I have collected relatively little patient information, and there is no statistical significance yet."
Zhou Congwen is well aware that the diagnosis, differential diagnosis, treatment, and pathophysiology of each disease require a wide range of samples.
Although the boss has a certain understanding of giant tracheobronchitis and can solve the difficulties encountered clinically, the age he lives in limits the number of patients.
The Internet played a decisive role in this.
There are already doctors communicating on the Internet platform. After a few years, the communication will become more frequent, and more and more doctors will join in, and many cases will appear in front of the doctors.
From this point of view, the Internet is indeed a magic weapon.
It's not that the boss can't do it, but that historical limitations make people like the boss helpless.
Mr. Huang then asked some related questions, and Zhou Congwen answered them fluently.
Huang Lao was very satisfied with this.
The operation was completed very quickly. As long as the problem of one-lung ventilation is solved, cutting a lung lobe is an extremely simple minor operation for the 912 professor.
After all, Huang Lao has the final say on his one-acre three-point land, and 912 has already fully rolled out thoracoscopy.
After the operation was finished, Mr. Huang got up, "Go back and continue reading the medical records."
"Okay, boss."
"Little Zou."
"I'm here, Mr. Huang."
"For one-stop surgery with small incisions, you have to match a good hand. During the operation, you need to repeatedly ventilate one lung and both lungs, and you need to run in advance." Huang Lao took the trouble to tell.
"Old Huang, I'm going to do it myself." Director Zou said.
Director Zou was still a middle-level doctor when Mr. Huang participated in the World Surgery Competition, and he was also greedy looking at it.
With such a great opportunity to brush up his resume, Director Zou had long wanted to volunteer.
Just in time for today's incident, Director Zou said it directly.
"That's fine." Huang Lao didn't refuse, and said directly, "Two days, 10 operations, we have to stay."
"!!!"
Although Director Zou had long been mentally prepared, he had five bypass surgeries a day, and the amount of surgeries made him inexplicably suspicious of his life.
Do you want to be so fast!
Even though he had expected it long ago, Director Zou was still taken aback after hearing Huang Lao's affirmative words.
"There are a lot of operations, and the more meticulous it is at this time. You can't make mistakes in your busy schedule, that's not an excuse."
Chapter 0893 what can I give
Director Zou accompanied Mr. Huang to change clothes.
It is easy to invite God, but naturally you have to send God away. This is the most basic etiquette.
"Old Huang, if it wasn't for you... and Xiao Zhou, I don't know how to deal with this situation."
Huang Lao didn't speak, just sighed.
Deng Ming and Zhou Congwen didn't dare to interrupt their boss's meditation.
After about a minute, Mr. Huang sighed deeply, "I'm old, I thought you all knew. Shen Tianci, who performed surgery on me a few years ago, was not at 1. I remember that the anesthetist at that time should be Han Yong." Bar."
"Han Yong also resigned last year." Director Zou said helplessly.
Zhou Congwen knew that his boss was thinking about inheritance.
If you have seen a rare disease once, you should have experience the second time.
However, due to various reasons, the inheritance was broken. If it wasn't for the presence of the boss, and if it wasn't for the coercion of myself, although the person would not die today, the operation would not be possible.
"I heard that Han Yong has become the chief director of the International Plastic Surgery Hospital. It's nourishing. Boss, don't worry." Deng Ming quickly changed the subject.