crazy scalpel

Chapter 57 Anesthesia

When Xie Ke saw Cai Tianqiao, he was shocked. For some reason, he always kept a respectful distance from Director Cai.

Neurosurgery operations often take a long time, so they are usually scheduled very early.If there is an operation outside the brain that day, the queue will usually start from the first one in the morning.

So it is reasonable for Xie Ke to meet the doctor outside the brain here.

And the unexpected place, of course, refers to Director Cai's own action, which also shows from the side that this operation should be a bit difficult.

Cai Tianqiao was sitting on the bench, with his hands habitually turned upside down and his head resting between the back of the chair and the wall at a seemingly comfortable angle.

As a junior, Xie Ke should go up to say hello, but he tiptoedly planned to cross the lounge without disturbing Cai Tianqiao.

Just when he thought he was going to succeed, Cai Tianqiao's voice came from behind.

"Hey, isn't this our Gu Yi's little craniotomy expert?"

"..." I knew it wasn't going so well.Xie Ke turned around and saw Cai Tianqiao looking at him with sparkling eyes, and almost suspected that the other party was waiting for him here from the beginning, "Hello, Director Cai."

Cai Tianqiao shrugged, "You ignore me."

"No," Xie Ke replied quickly, he knew that Cai Tianqiao would find fault, "I just don't want to disturb your rest."

Cai Tianqiao obviously wouldn't just let him go like this, "You also know that I'm just resting, not sleeping."

"Okay, I was wrong." Xie Ke knew that when he encountered such a faultfinding person, it would usually be useless to entangle him, although he didn't know why Cai Tianqiao treated him specially, intentionally or unintentionally.But he knew that at this time, he should be gentle, "I will call you next time."

Director Cai, who was regarded as a big cat: "..." The other party admitted his mistake with such a humble attitude, and he couldn't hold on to it.

Cai Tianqiao gave a fake cough, "I heard that Daqiang refused my meningioma operation in order to cooperate with you today?"

Daqiang is Feng Daqiang, whose real name is Feng Daqiang, the best anesthetist in the city, even in the entire Tianhai City, he is also first-class.

Feng Dada hates people calling him by his real name the most, and Cai Tianqiao is probably the one who dares to call him that.General deans, directors, etc., call him Xiaofeng.

Xie Ke somewhat understood why Director Cai was waiting for him here.Yes, at this time he had already determined that Director Cai definitely did it on purpose.Because he smelled a vinegar smell, sour.

I just don't know whether Cai Tianqiao is looking at surgery or people?Or maybe both.

But from a doctor's point of view, Xie Ke still admires and appreciates Feng Dada's choice.Although Cai Tianqiao's meningioma surgery is difficult, it is not complicated, and the requirements for anesthesiologists are the same.Relatively speaking, Xie Ke's cranial suture reconstruction surgery has higher requirements for anesthesiologists than for surgeons.

Because it is a baby, it must be very sensitive to the fluctuations in the values ​​of various monitoring items for anesthesia management.For intravenous inhalation compound anesthesia, the anesthesiologist's hand feeling is also very important.The other anesthesiologists in the city's first hospital are of course also good.If they are given general pediatric anesthesia, they will be fine.

But neurosurgery, or anesthesia for craniotomy, they have to weigh it.The supply of anesthetics, the speed of infusion of balance fluid, the use of muscle relaxants and the timing of use.The most important thing is that there is no problem during the operation, how to control the recovery time after the operation?

Not without other anesthesiologists eager to try, just like surgeons, anesthesiologists also like to collect cases.Every clinician has a first time. If the first time is not given, there will never be a senior physician.

But total craniosynostosis, after all, is a very rare special case.Given that those anesthesiologists hadn't even done anesthesia for ordinary pediatric neurosurgery, how could Xie Ke rest assured to entrust them with the important matter of anesthesia?

So he went to find Feng Daqiang.

Feng Daqiang was very interested. Since the last time he had brain cysticercosis removed, Xie Ke hadn't done any more difficult operations, so he didn't meet Feng Daqiang much.

Xie Ke's ability left a very deep impression on Feng Daqiang, and when he learned that the patient was a baby, Feng Daqiang resolutely agreed.But he didn't tell Xie Ke that in order to perform Xie Ke's operation, he pushed Cai Tianqiao's.

"..." Xie Ke, who had just learned about this matter, felt that Director Cai had the aura of a king under the city.Should he explain the surgery first, or should he explain that he has no intention of robbing people at all... What should I do, wait online, hurry.

Seeing that Director Cai's face became more and more gloomy, Xie Ke felt that it was better not to wait any longer.

He chose to explain the operation first: "The anesthetist in our hospital has little experience in pediatric neurosurgery, and Feng Dada has the best anesthesia skills, so I went to him." First highlight the surgical needs, and then tout the technical level, Finally, he added: "I didn't know that your operation was also today, otherwise I would have rescheduled it. After all, Feng Da is your queen."

This flattery should be comfortable enough.

Cai Tianqiao's expression softened a lot.

The main reason is that Director Cai thought to himself, with my standard, there is no difficulty in surgery without Daqiang.As long as you do it quickly, you don't need the anesthetist to keep increasing the dose.Using Feng Daqiang is just a matter of habit.

Cai Tianqiao asked Xie Ke: "Have you always wanted to come to our department?"

When Xie Ke didn't know how to answer Cai Tianqiao, the nurse in No. 1 operating room came out and called him, "Director Cai, first assistant opened the cranial hole."

Cai Tianqiao said to her: "Let him continue, I will come right away."

Taking advantage of this time, Xie Ke sneaked away to change his clothes and disinfect his hands.Halfway through the brush, Cai Tianqiao came in again.

"..." Xie Ke's face is full of doubts, hasn't he checked it, isn't he going to let me go, "?"

Cai Tianqiao came over and stood near him, and began to brush his hands too.

Xie Ke flicked his fingers in front of Cai Tianqiao boredly, but Cai Tianqiao couldn't see it, only Xie Ke could see it.

After a while, Cai Tianqiao finished brushing, after all, he had done it before.Before leaving, he said to Xie Ke as if thinking of it temporarily: "Do well, don't smash the signboard of our hospital."

Xie Ke bets that he actually wanted to tell himself that all along!But he hasn't said that he wants to transfer to another department, this director Cai is so sure!This gave Xie Ke a feeling of being at a disadvantage.

After finishing preparations, Xie Ke entered the operating room, and Feng Da laughed when he saw him. "Is Lao Cai waiting for you outside?"

Xie Ke stared, "You know?"

Feng Dada smiled wretchedly, "To deal with such a person sometimes you need to play hard to get. I will teach you after the operation."

Xie Ke: "!" After Tong Wenjie, another new plane is opening to him.

Feng Dada joked, but soon got to the point, "The respiratory infection is relatively serious, and the cardiovascular evaluation is not good. After all, pulmonary valve stenosis cannot be cured, but the intracranial pressure is not too high. For you should be no problem."

Xie Ke nodded. He was confident. "The family members of the child thought it was a common cold. The upper respiratory tract infection was treated after admission. Does it affect the maintenance of anesthesia?"

It's easy to tell people who understand things, Feng Da: "I'm going to tell you this, babies are already difficult, I'm afraid it's not possible to use basic anesthesia like this now, and acute respiratory infection needs to be considered. I want to switch to inhalation anesthesia plus intravenous, You can see if it works."

The basic anesthesia and local anesthesia in the original plan were suggested by Xie Ke.Basic anesthesia is generally suitable for craniocerebral injuries with short operation time and simple operations, such as debridement and suture, reduction of depressed fractures, meningocele repair, etc., as well as various angiography for auxiliary diagnosis.If the operation time exceeds half an hour, the initial amount can be increased by half or one third as appropriate.

Because Xie Ke is very confident in his speed and level, he feels that he can complete the first phase of bone suture reconstruction within half an hour.Therefore, he suggested that Feng Dada use basic anesthesia.

Because all inhaled anesthetics will dilate cerebral blood vessels to varying degrees, increase cerebral blood flow and cerebral blood volume, and cause a corresponding increase in intracranial pressure.

The mac value of inhaled anesthetics, that is, the minimum alveolar effective concentration, is related to age.The younger the age and the lower the mac, the stronger the effect of the anesthetic.

The stronger the effect of the anesthetic, the greater the inhibition on the cardiovascular system, and the smaller and more precise the dosage must be.

Xie Ke hoped to use basic local anesthesia for Guan Yao, also for the sake of the child's physical ability to sustain surgery and prognosis, but what Feng Da said cannot be ignored.If laryngospasm is caused in order to reduce intracranial pressure, it is not worth the candle.

After all, if the intracranial pressure is high, besides the anesthetist, Xie Ke can also find a way to control it.

Thinking of this, Xie Ke said to Feng Da: "Then take a relatively safe compound anesthesia."

Feng Da began to induce anesthesia on Guan Yao, while Xie Ke stood aside and watched.

If it is a general anesthetist, it will directly use the venipuncture.But because the patient is a baby and doesn't know how to be patient, this step can easily cause the child to cry and make the already high intracranial pressure rise even higher.

And Feng Dada's value is reflected here, he used inhalation induction.Complete venipuncture under relatively shallow inhalation anesthesia to avoid excessive anesthesia caused by too long inhalation time.During artificial ventilation, Feng Dada prevents gastric inflation by compressing the cricoid cartilage, and uses low tidal volume and fast frequency to control the partial pressure of carbon dioxide in the arterial blood to a normal level.

Xie Ke watched silently from the side.Good teammates are indeed very important, but they can be met but not sought after.

After successfully anesthetizing Guan Yao, what Feng Dada needs to do is to maintain and monitor various values.

Xie Ke began to correct Guan Yao's posture.

This time his speed is very fast, unlike Tong Wenjie before.

Tong Wenjie's operation, because of the relationship between the overall time and the placement of the drainage tube, relatively speaking, did not require a lot of time for positioning, craniotomy and craniotomy.Because no matter whether you are dawdling or neat, it will not affect the entire operation time.So when Professor Xu asked Xie Ke to do these things, others were not very surprised when they didn't know Xie Ke's level.

But this time is different. This time, the speed with which Xie Ke does these tasks will directly determine the duration of the entire operation.

As soon as Xie Ke moved, the atmosphere in the operating room immediately became tense!