Chapter 21: 0021 Flirtatious Operation

Lift the pregnant woman onto the bed, adjust the operating table's angle, tilt left 15 degrees.

This is to shift the pregnant uterus to the left, making it easier to locate the appendix. It also reduces excessive uterine stimulation during surgery to avoid aggravating threatened miscarriage and other complications.

Preoperative preparations were quick, and Xie Yiren was already in position.

Zheng Ren scrubbed up, put on his gown, laid out the sterile drapes, and took the surgeon's position.

"0.5% lidocaine, plus half a tube of milk." Zheng Ren said.

Milk is the nickname for propofol, an anesthetic induction agent generally used in the induction of general anesthesia and continuous epidural anesthesia; its effect for local anesthesia is not strong.

The anesthetist hesitated for a moment, wanting to argue something, but seeing Zheng Ren's focused demeanor, he held back.

He even dares to perform appendectomy on a pregnant patient without anesthesia—what else wouldn't he dare to do?

"5ml syringe, switch to a 1ml needle." Zheng Ren stood under the shadowless lamp, his silhouette slightly tall. Every word was extremely firm, leaving no room for doubt.

The finer the syringe needle, the less pain stimulus to the patient, but pushing the anesthetic becomes more difficult.

Starting anesthesia, his skilled and rhythmic infiltration anesthetic movements left the anesthetist feeling refreshed and delighted.

After each injection of medication, he would pause a few seconds, waiting for the lidocaine mixed with propofol to take effect before proceeding to the next step. His technique was gentle yet precise; judging from the patient's vital signs, there was basically no needle‑prick pain from the syringe.

Really impressive, no wonder he dares to perform local‑anesthesia appendectomy.

The anesthetist is a connoisseur; the more he watches, the more absorbed he becomes.

In the demonstration room, Director Pan and Director Liu exchanged expressions.

When he saw the patient had pregnant appendicitis, Director Pan set aside his old copy of the "Guan Zhui Pian".

When he saw Zheng Ren preparing for local anesthesia, Director Pan began to feel anxious.

"Director Pan, your vision is truly impressive." Director Liu thought he already had victory in the bag, that Zheng Ren was courting death and couldn't blame himself; feeling relaxed, he began to trash‑talk the overconfident opponent.

"I haven't done a local‑anesthesia appendectomy in many years, Director Pan. Back when you worked at county‑level hospitals and in the military, you probably did them often. I guess Zheng Ren learned from you; today I also want to study well and sharpen my skills."

After saying that, Director Liu shifted to a more comfortable posture, smiling as he watched the projection showing Zheng Ren already beginning local anesthesia.

Director Pan wanted to retort, but he had no mood for it now.

Already past midnight, the Xinglin Garden Website suddenly saw hundreds of accounts log in at once, rushing in and crowding into a video livestream.

【Good heavens, what am I seeing? Pregnant appendicitis! And they're doing it under local anesthesia! Is this the god‑like streamer showing off a crazy stunt?】

【You don't understand anything—sit down properly, you're blocking my view.】

【I've never done a local‑anesthesia appendectomy before; this time I really need to study it carefully. I hope the expert does it slowly so I can quickly notify others to come watch.】

【Have you ever performed a local‑anesthesia appendectomy? I haven't—I'll drag over a small stool to learn properly from the expert.】

【Never done +1.】

【Never done +2.】

【……】

【Never done +10086.】

Every account on Xinglin Garden belongs to a doctor. This is a professional website that requires real‑name verification and a practicing physician's license for review standards.

The basic anesthesia for appendectomy is continuous epidural anesthesia, which is commonplace.

Those who stayed up this late are all young doctors around thirty years old; astonishingly, not a single person present has ever performed a local‑anesthesia appendectomy, even though they are professional physicians.

【Why is the anesthetic in his syringe cloudy?】

【I just heard something about adding propofol—does anyone from anesthesiology have an idea? Explain the principle behind this flamboyant maneuver.】

【I'm the associate director of anesthesia at a certain tertiary hospital, and I'm completely baffled—I have no idea what's going on.】

As the surgery just began, a group of professional doctors entered a state of bewilderment.

Local‑anesthesia appendectomy is an unfamiliar procedure—no doubt about it. Not even understanding the anesthetic the surgeon injects? That's going a bit too far.

The barrage of comments began to flood the screen.

【Why pause a few seconds after each injection? What's the principle?】

【Probably to let the local anesthetic take effect and avoid stimulating the patient. The onset time for 0.5% lidocaine infiltration anesthesia is usually around 12 seconds, so why is his interval between injections only about 3 seconds?】

【Could this be the effect of propofol?】

【I've already fallen to my knees—please, O expert, accept my kneeling.】

【Damn it, stop spamming the barrage—watch the surgery, watch the surgery!】

Finally, the barrage from those urging silence to watch the surgery was drowned out by a dense flood of comments, disappearing in the ocean of the masses.

【I remember that for pregnant appendectomy the textbook says to make a McBurney point incision lateral to the right rectus abdominis; why does the expert's incision feel a bit high? Did I misremember?】

【Maybe he's doing a physical‑exam differential diagnosis to confirm the appendix's location.】

【A 5 cm incision for mid‑trimester pregnant appendicitis—what confidence that takes!】

Although it was just one appendectomy, everyone watched with great interest. As the surgery began with the skin incision, the barrage gradually tapered off.

……

……

Zheng Ren used a knife to cut the skin, performed blunt dissection of the subcutaneous tissue and muscle, and opened the peritoneum.

Every step required anesthesia with the local anesthetic; the procedure was not swift, but it was steady.

The anesthetist looked at the surgery, looked at the ECG monitor, then turned his head to look at the surgery again; having reached the peritoneum, the patient's blood pressure, heart rate, and respiration were all stable.

This meant Zheng Ren's local‑anesthesia effect was excellent; the patient felt no pain from the surgery.

Really a freak, the anesthetist thought to himself.

Zheng Ren had already pushed to his limit; even if a professional anesthesiologist took over, they wouldn't achieve such a perfect performance. Could it be the effect of propofol? Should we test it in the next surgery?

The anesthetist quickly shook his head, driving that unrealistic notion out of his mind. Better to stick to conventional anesthesia; if anything went wrong, his slight shoulders couldn't bear the responsibility.

After opening the peritoneum, Zheng Ren used a curved clamp to probe and directly grasped the appendix out.

The curved clamp lightly grasped it, applying no extra force to the swollen, fragile appendix.

One hand holding the mid-bend, the other hand reaching out to Xie Yiren's face.

The small bend was slapped into Zheng Ren's hand.

"Don't the small bend." Zheng Ren slapped the small bend back, saying: "Syringe."

Xie Yiren realized, this is not the appendectomy she usually does, but an appendectomy under local anesthesia. She cannot directly clamp the ligaments and artery around the appendix; local anesthesia is also needed.

Having followed the appendectomy until bored, Xie Yiren's eyes sparkled with little stars, as if she had found a new toy, intently staring at Zheng Ren's movements.

After skillfully injecting the anesthetic, Zheng Ren picked up the small bend and began separating the ligaments.

Zheng Ren felt unfortunate; at a critical moment, he actually encountered a patient with appendicitis during pregnancy, and moreover had to perform it under local anesthesia.

Although he had specifically practiced the local anesthesia appendectomy operation in the System Space, this flamboyant operation he would avoid if possible, as there are too many accidents.

Fortunately, this case of pregnancy-related appendicitis is relatively simple.

Because of the pregnancy, the uterus enlarges, pushing away the greater omentum that should normally cover the area around the appendix. If the appendix were to perforate, without the greater omentum's protection, the patient would suffer severe complications, and intraoperative handling would be very troublesome.

The patient before him, whether due to clear diagnosis and timely treatment or because she is young, healthy, and has strong immunity, her appendix swelling has reached the limit yet has not perforated.

The inflammatory exudate around the appendix is also not severe.

Truly a great fortune.

Zheng Ren began to excise the appendix, ligate the appendix artery, after purse-string suturing the appendix stump he added an extra reinforcing stitch.

The surgery was completed cleanly and neatly.

Successfully, beyond everyone's expectations, whether in the demonstration classroom or Xinglin Yuan, all fell into a hushed silence.