Chapter 2829: 2626 All‑Round Transcendence

"Boss, Lao He isn't here—do you feel like you're missing something?" Su Yun stood in the Operating Room, preparing equipment while chuckling and asked.

"Mm, I'm used to it." Zheng Ren nodded and said.

"But we can't bring the entire Medical Team every time we go out—that wouldn't make sense."

"You bragged about Lao He in Yangcheng, and I heard him say there's an anesthesiology academic conference this weekend; Yangcheng's Director Qiu will definitely come to see Lao He." Su Yun said.

"It's not bragging; Lao He's skill is definitely high." Zheng Ren said, "Otherwise, that separation surgery for the conjoined twin heart couldn't have been done."

"It's still because you scolded him."

"When did I ever scold Lao He?"

"Artistic exaggeration, don't be so nitpicky, okay?" Su Yun adjusted the operating table and asked, "The semi‑recumbent angle can only be this much—do you think it works?"

Zheng Ren nodded, "As long as the patient can tolerate it, it's fine."

"Generally speaking, surgery requires a supine position, but the patient before us has an airway obstruction, low oxygen intake, so cardiopulmonary function is problematic and they simply cannot lie flat."

"This is also a common trait among many late‑stage lung cancer patients, also known as orthopnea."

"Lying down for surgery is impossible, so we have to make do, changing the surgical position to a semi‑recumbent posture."

"The patient was soon brought in, lifted onto the operating table, placed in a semi‑recumbent position with an oxygen mask, receiving oxygen at 10 L/min."

"Seeing the patient's good blood‑oxygen saturation, Zheng Ren made a gesture, and together with Su Yun they scrubbed in preparation for surgery."

"The right femoral vein was percutaneously cannulated with a 28F venous catheter for drainage, and the left femoral artery was percutaneously cannulated with a 20F arterial catheter for infusion."

"Afterwards, they waited quietly for 30 minutes before initiating VA‑ECMO."

"After ECMO was started, Zheng Ren made a gesture."

"But he immediately realized this wasn't in the country, and Lao He wasn't by his side."

"Su Yun noticed, laughed haha, and said, 'Boss, you just said that and already forgot.'"

"Mm, really just a habit." Zheng Ren said, then began communicating with the anesthesiologist from Bota.

"The vein was given propofol‑based basic anesthesia and sedation, then the patient's position was changed to supine. The patient, who originally could not lie flat, entered a supine state under ECMO's effect without showing any abnormal reaction."

"Blood‑oxygen saturation was good, vital signs stable, everything went smoothly."

"Only then did Su Yun exhale; the Nico doctor standing in the operation room felt a sense of loss."

"This idea is so simple—why didn't I think of it? In both of their minds, the same thought simultaneously surfaced."

"Su Yun, you watch the ECMO; I'll perform the surgery with Fugui'er." Zheng Ren said.

"Okay, Boss." Professor Rudolf Wagner replied cheerfully.

"Su Yun didn't say more, but kept staring at the machine. The circulatory system was primed—fresh plasma 100 mL, Lin Ge fluid 400 mL, heparin 2 mg/kg; during flow we monitored MAP and SaO₂. Flow rate was 2.5 L/min, keeping SaO₂ above 90%."

"Everything was perfect; he made a gesture indicating Zheng Ren could begin the procedure."

"The data on the ECG monitor also pleased Zheng Ren; the patient had a fiber bronchoscope inserted through the nose."

"Through the screen, Zheng Ren saw an externally compressed narrowing with an intraluminal neoplasm in the mid‑trachea, the lumen basically occluded. He began selecting a guidewire, gently advancing it along the patient's airway."

"Just as predicted, the airway differs from the esophagus; as long as the patient is alive, the main airway cannot be completely occluded."

"Although the airway pathway was twisted, Zheng Ren easily threaded the guidewire down."

"\"Boss, should we do the wire‑guiding or use the bronchoscope? \" Su Yun asked."

"\"Wire‑guiding. \" Zheng Ren still chose the most reliable method."

"Although simply observing the stent with a bronchoscope would be possible given the patient's condition, it isn't as intuitive as looking at it with a DSA machine."

"An 18 mm × 40 mm nickel‑titanium alloy tracheal stent was delivered to the position, then released and the delivery system withdrawn. Zheng Ren began aspirating bloody secretions and used biopsy forceps to adjust the stent's position; under the DSA machine the tracheal stent could be seen expanded, restoring airway patency."

"\"We can stop ECMO now. \" Zheng Ren said."

"Su Yun then began communicating with the anesthesiologist on this side, using protamine to neutralize and halt ECMO operation."

"The actual ECMO runtime was only 12 minutes and 26 seconds; the surgery was simply completed."

"A surgery deemed inoperable by Bota was carried out without a hitch."

"Zheng Ren didn't rush to send the patient back; he observed in the operating room for a full 30 minutes, even longer than the actual surgery time."

"Such caution left Su Yun thoroughly convinced."

"\"Doctor Zheng, your thinking is truly impressive. \" The Nico doctor entered the operating room and communicated with Zheng Ren. This surgery didn't show Zheng Ren's surgical skill; it was mainly about an alternative use of ECMO, which opened Nico's thinking."

"\"Mm, the surgical process is still a bit slow, and coordination has some issues. \" Zheng Ren's eyes kept shifting between the ECG monitor and the patient."

"\"The coordination is already quite good! \" the Nico doctor exclaimed in surprise, \"Is Doctor Zheng really saying that? The longest delay in the whole surgery was his postoperative observation of the patient. \""

"\"The ECMO turnover, if my anesthesiologist were here, could be controlled at around six minutes. \" Zheng Ren said without even looking at the Nico doctor, just chatting casually."

"Six minutes…"

"That number left the Nico doctor extremely surprised."

"Only a well‑trained medical team can keep ECMO initiation under fifteen minutes; whereas in this case, Zheng Ren's pre‑surgery ECMO start time was thirty minutes."

"That time isn't long; it's just normal."

"But six minutes—is that really okay?"

"\"Good heavens…\" the Nico doctor, who had been amazed by Zheng Ren's surgery and thinking, hadn't expected him to be discussing ECMO initiation time with her."

"\"Could it be that Doctor Zheng is telling me his medical team has completely surpassed both me and Bota Private Hospital? \""

"Su Yun glanced at her own boss and smiled, 'Boss, you keep praising Lao He—won't he get conceited?'"

"\"Speaking frankly. \" Zheng Ren said, \"Recovery is still good; let's prepare to send him back to the ward. \""

"In the System Operating Room, the assistant assisting the surgery should be modeled after Lao He; indeed, only six minutes were used in the ECMO pre‑warming phase. Zheng Ren merely spoke frankly, with no exaggeration."

"\"Doctor Zheng, is there anything special to watch for after the surgery? \" the Nico doctor asked."

"\"One day later, get a CT to check if the tracheal lumen is patent and the stent position; two days later, do a bronchoscopy to see if the mid‑tracheal stent is fully expanded. \" Zheng Ren said, \"Otherwise there's nothing else—the patient's breathing difficulty has been resolved; all that's left is to rest a few days, let the body recover, then proceed with the next treatment. \""

"Having said that, Zheng Ren left the operating table, turned around, removed his sterile gloves, and tossed them into the medical waste bin."