The shadowless light in the classroom operating room was on, and Su Yun stood in front of the operating table and complained, "Boss, don't change the isolation suit or wear sterile clothes, there is no sense of ritual at all."

"Then let's change it. We probably have to squat here for a while. If we change to the isolation suit, we will definitely feel more comfortable." Zheng Ren replied indifferently.

"It's still half an hour before the printed lungs can be delivered."

"Don't worry, I have something to do with you. Lao He, come." Zheng Ren greeted Lao He.

Lao He hurried over and smiled, "Boss Zheng, your instructions."

"When I got on the ecmo, the pipeline tremor occurred. Do you have any good solutions?" Zheng Ren asked.

"It is highly likely that it will happen. There is no way to estimate the frequency and intensity of tremors in advance. I can only adapt to the situation in the operation and continuously adjust the flow to deal with it." Lao He replied.

"Be careful about this." Zheng Ren instructed, and then began to study the dosage of anesthetic drugs with Lao He.

Anesthetic dosage has standard calculation formulas, and the input amount of anesthetic drugs is calculated based on kilograms of body weight or even the body surface area.

But Xiao Shitou's condition is a little special. Although he has gained weight recently and looks closer to a normal child, he must not be regarded as a normal person.

The dosage of medication should also be changed in the calculation results of the basic formula and reduced to a certain amount to avoid excessive damage to the body.

If you really get to the most detailed point, there is a big statement about the pumping speed of every medication and every micro pump.

Lao He was cautiously pricking his ears to listen, but as time went by, he said more and more.

Boss Zheng wants the most accurate values, the smallest surgical trauma, and anesthesia blow.

Based on scientific calculations, Lao He combined his many years of rich clinical experience to make certain changes to the values ​​Zheng Ren found in the system operating room.

While discussing with Lao He, Zheng Ren went to the system operating room to study experimental questions after getting the numbers.

At this point, Zheng Ren fully utilized the advantages of a snatch.

The dose given by Lao He is only the limit that an anesthesiologist with rich clinical experience can do. It is just speculation that the specific needs to be adjusted according to the intraoperative situation.

Zheng Ren took Lao He's speculation to the system operating room without any scruples, and after he came out, he made more subtle adjustments.

Lao He didn't think it was abnormal about Boss Zheng's "deduction". In his opinion, Boss Zheng has already pointed out the skill points in "deduction" ability.

The Women and Children's Hospital involved a lot of anesthesia cooperation. Every time there were difficulties, Boss Zheng would enter a meditation state. However, this state did not last long, so he woke up and had new opinions and opinions.

As it turns out, Boss Zheng’s opinion was correct.

Lao He has always admired Boss Zheng for this, so he simply took out a pen and paper and wrote down the results of Boss Zheng's deduction.

This is what you have to do during the technique.

"Boss, I've had surgery training!" Su Yun greeted.

"Wait, you guys come first, Lao He and I have something to say." Zheng Ren shook his head, and was still studying anesthesia with Lao He.

Lao He has already written a piece of a4 paper in his hand.

Su Yun came over and listened to a few words. The problem of pipeline tremor had been solved. The boss and Lao He were talking about the auxiliary value of the ventilator after starting the ecmo assistance.

It's still early. After talking about the ventilator, there is also the question of whether to deal with external circulation.

Lung transplantation is said to be surgery, but the surgery method is not the most critical. It cares more about the details. If you want to succeed, from anesthesia to surgery to severe ICU, everyone in the overall team must play their greatest role.

Su Yun knew that during lung transplant surgery, the ventilator changed from a device that supports oxygenation and ventilation to a tool that reduces systemic inflammatory reactions.

During ecmo transfer, both lungs still provide a small portion of gas exchange, but ventilation strategies are mainly aimed at over-expansion or collapse and damage. As the dependence on the lungs during ecmo decreases, ventilator management changes to lung protection strategies that reduce to the amount of tidal gas corresponding to the ideal weight.

Generally speaking, 6ml/kg is a relatively ideal value. But the boss is not satisfied with this "rough" theoretical value and is still using cumbersome formulas to calculate with Lao He. And this guy is constantly "in a daze", is his brain going down?

This time, even Su Yun was stunned.

Although low tidal volume is a standard lung protection strategy, reducing the driving pressure of the lung, that is, reducing the pressure difference between the peak airway pressure and the positive end-expiratory pressure, and avoiding lung tissue collapse, are very critical to recovery.

Collapsed lungs require higher pressure to overcome atelectasis, which is to overcome the natural lag when insufficient ventilation. This results in increased pressure and loss of surfactants can further aggravate the inflammatory response.

These details have been separated from the scope of simple surgery and do not fall into the scope of anatomy, but are physiological.

In the study of lung tissue, the boss is so delicate, which makes the star of tomorrow in the imperial capital cardiothoracic surgery feel so good.

Su Yun was quite powerless. He listened carefully for more than ten minutes, and the various tedious formula calculations and the values ​​calculated by Lao He based on years of rich clinical experience were already a nearly perfect anesthesia operation, but the boss was not satisfied at all.

He regulates the positive end-expiratory pressure based on the individual's airway peak pressure.

Su Yun understands the truth - since ecmo can directly transport oxygen to the blood, the inhaled oxygen concentration of the ventilator can be reduced to a minimum to avoid oxygen toxicity.

Although no conclusions have been made about the optimal mode and exact target of the ventilator during ecmo assist, the oxygen partial pressure is greater than 60 mmhg and the oxygen saturation is greater than 80% during the traditional oxygenation target.

But tradition... has already ruined the boss.

After making subtle adjustments again and again, the a4 paper in Lao He's hand was already full of 3 pages.

"Boss, you guys study it first. I'll take Lin Yuan and Xiao Ran to get familiar with the operation first." Su Yun was very helpless. Even after hearing so many things, his mind felt a little uncomfortable.

As for Lao He, judging from the guy's appearance, I guess he would be afraid of fainting after researching it.

Zheng Ren has been almost the same as Lao He's research, and he is also satisfied with this. Anesthesia is the basis, especially for sequential double lung transplant surgery assisted by ecmo.

Using the plan developed with Lao He, Zheng Ren entered the system operating room again and began surgical training.

Zheng Ren felt very happy that the completion of the operation was increased by 3-4 percentage points.

However, during the fifth surgical training, Zheng Ren had just begun to meet the main trachea, and the breathing cycle of the experimental subject actually changed drastically.
Chapter completed!