Chapter 3165: 2960 Going All Out

"Boss, anesthesia is a big problem." Su Yun said, "The extracorporeal circulation team can only find Lao He to do it first; we can't occupy a team's personnel for that long."

"Um, at that time Lao He will have to go back and forth to look after things. Any problems between ECMO and extracorporeal circulation, Lao He will have to keep an eye on them." Zheng Ren understood Su Yun's meaning.

"Right, since Lao He can't keep an eye on everything, do you want to call Da Chu and Xiao Chu over?" Su Yun asked.

"Is it convenient at home?"

"If you say it's okay, I'll ask again; otherwise, if Da Chu and Xiao Chu come and you say no, that would be awkward."

"Come on, I'll talk to Director Xu about it; after all, we need to do surgical training for about a week, and it's not easy to find other anesthesia staff to accompany us the whole time." Zheng Ren nodded and settled the matter.

Lin Yuan and Gu Xiao Ran rubbed their palms in anticipation; anyone who has done clinical work for a while knows this operation will surely go down in history.

Autologous stem cell cloning, 3D-printed lung transplant will inevitably write a bold chapter in medical history, perhaps even turning into an invisible hand that flips the pages of modern medical history.

Wait for Yi Ren and Lao He to get together, then go to the community hospital to prepare for surgical training.

The last time such extravagant pre‑operative training was done was during the separation surgery for conjoined twin hearts at the women and children's hospital.

Speaking of the operation as a whole, the difficulty is less than separating conjoined twin hearts, but Zheng Ren still prepared to give it his all, leaving no effort spared.

He even without hesitation gathered the entire medical team again.

Watching Su Yun bring Gu Xiao Ran and Lin Yuan to move the 3D-printed simulator onto the operating table in the demonstration room for pre‑operative preparation, Zheng Ren took the opportunity to go to the system space and purchase surgical training time.

As the system operating room rose up from the ground, Zheng Ren silently prayed a sentence, then stepped inside.

Fortunately, just as imagined, the 3D‑printed cloned lung tissue lay in the operating room, so there was no need to spend a high price buying it from the system mall.

Zheng Ren expressed his satisfaction with this.

The operation starts with anesthesia. Zheng Ren didn't dump all of this on Lao He, after all, the 3D‑printed simulator and a real person are essentially different.

Zheng Ren began trying anesthesia and ECMO.

First, give the experimental subject a mask to inhale pure oxygen, volume fraction 100%, monitor ECG and oxygen saturation. Then Zheng Ren performed right radial artery puncture catheterization to monitor invasive blood pressure, and conducted blood gas analysis.

For anesthesia induction, use midazolam 1–2 mg, etomidate 0．2～o．4 mg/kg. Sufentanil 0．2～o．4 mg/kg and rocuronium bromide 0．15～O．3 mg/kg.

After entering muscle relaxation, begin tracheal intubation and connect to the ventilator to assist breathing.

Maintain anesthesia with intravenous propofol 0．03～0．05 nag·kg·1·min, vecuronium bromide 1～2 ug/kg/·min, and also intermittently inject fentanyl intravenously to maintain anesthesia.

Zheng Ren observed the experimental subject's condition for a period of time and intermittently performed blood gas analysis.

The blood gas values were not stable; because the ventilation mode was pressure‑controlled, Zheng Ren adjusted ventilation parameters according to blood gas analysis indicators and vital signs, deciding to perform manual ventilation when necessary.

After anesthesia induction, perform right femoral artery and vein cannulation; the femoral artery uses a 15–17 Fr catheter advanced to the level of the common iliac artery; the femoral vein uses a 19–21 Fr catheter advanced to the level of the inferior vena cava. Choose a heparin‑coated membrane lung and tubing, a heat exchanger, centrifugal pump head, and oxygenator. After the catheters are placed in the patient, immediately begin flow diversion.

The maximum ECMO flow is usually determined by the cannula. Each cannula has its own flow‑pressure curve; the larger the cannula, the higher the flow. For example, a 17‑Fr arterial cannula can only reach 4–5 L/min, while a 21‑Fr cannula can achieve 6 L/min without exerting extra pressure on the tube wall.

Taking Xiao Shitou's age into account, Zheng Ren tried many times and finally selected the most suitable cannula size.

The initial flow was set at 50 % of intermittent cardiac output; during flow diversion it was kept above 30 %, and during the operation the speed and flow were adjusted according to oxygenation and cardiac function.

Zheng Ren also did not purchase an assistant to help with the surgery; this time he was just gaining experience. Although there was still a lot of surgical training time left, Zheng Ren did not intend to "waste" it.

In this operation, Zheng Ren did not believe the 3D‑printed cloned lung tissue could perform perfectly. If an abnormality occurred, he planned to send Su Yun away and then "hide the sky from the sea", using lung tissue from the system space to replace the 3D‑printed lung tissue that Su Yun had brought from the laboratory.

Doing this carries great risk, but Zheng Ren had already made the worst preparations for the success of the operation.

Lung tissue that can be taken out for actual transplantation costs hundreds of thousands of experience points to exchange, more expensive than what was previously used in the system space.

Let's do it bit by bit; hopefully the lung tissue provided by Su Yun's side will be relatively reliable.

When the operation began, Zheng Ren discovered an abnormality.

Before the ECMO flow decreased, he observed the phenomenon of "pipe trembling".

This occurs because when the intravascular volume is at a low level, negative pressure in the ECMO circuit causes the venous cannula to strike the venous wall.

Continuous trembling could trigger an ECMO alarm or "suction wall leading to flow reduction"; after Zheng Ren lowered the ECMO flow, he found the trembling amplitude could be quickly relieved; subsequently he adopted the approach of expanding volume while slowly increasing ECMO flow to solve the problem.

Normally, pipe trembling during ECMO use is not uncommon; Lao He must have encountered it many times. But Zheng Ren still cautiously figured out the situation bit by bit, until he knew exactly how to expand volume and what dosage to give to avoid pipe trembling.

Just a single detail ended up wasting a full thirty hours of surgical training time.

As the operation grew larger, the consumption of surgical training time increased as well. Fortunately, the 3D‑printed simulator is available for training; otherwise, buying assistants in the system operating room would likely allow only a few training sessions.

However, what relieved Zheng Ren was that the 3D‑printed cloned lung tissue brought by Su Yun was quite good; after the operation the system actually gave an 88 % surgical completion rate.

This completion rate is low compared to the operations Zheng Ren has performed, but he has demonstrated that there is no essential difference between 3D‑printed tissue and tissue purchased from the system space.

As long as there's no problem, Zheng Ren also doesn't want to conjure lung tissue out of thin air like a living person.

A laryngoscope and a blade are trivial matters, easily explained away. Even if Su Yun or others had doubts, they would think Zheng Ren had obsessive‑compulsive disorder, just a coincidence.

But conjuring up a lung…

Selling human organs on the black market? If that were the case, once noticed the consequences would be unimaginable.

A cloned lung should be usable; this is the best news Zheng Ren has received.

Sixty‑two hours of surgical training have been poured in, and Zheng Ren feels his level is truly not bad. Organ transplant specialization, although Big Pig Trotter gave no explanation, Zheng Ren is confident that this specialty skill played a major role.