Chapter 3166: 2961 How Can One Bear the Feeling?

The shadowless lamp in the demonstration room operating room lit up, Su Yun stood in front of the operating table, complaining, 'Boss, not changing isolation gown, not wearing sterile clothes, there's no sense of ceremony at all.'

"Let's change it, we estimate we'll have to squat here for a while. Changing the isolation gown will definitely be more comfortable." Zheng Ren replied indifferently.

There's still half an hour before the printed lung can be delivered.

No rush, I still have something to do on my end. Lao He, come here." Zheng Ren greeted Lao He.

Lao He hurried over, smiling all over, "Zheng Lao Ban, your instructions."

When on ECMO, pipe vibration occurs; do you have any good solutions?" Zheng Ren asked.

It's likely to happen; beforehand we can't estimate the frequency and intensity of the vibration, only adapt intraoperatively, constantly adjusting the flow to cope." Lao He replied.

Be careful about this." Zheng Ren cautioned, then began studying the dosage of anesthetic drugs with Lao He.

Anesthetic dosage has a standard calculation formula, calculated according to kilogram body weight or even body surface area to determine the input amount of anesthetic drugs.

But Xiao Shitou's situation is somewhat special; although he has gained some weight recently and looks closer to a normal child, he absolutely cannot be treated as a normal person.

The drug dosage also needs to be adjusted from the baseline formula calculation, reducing a certain amount to avoid causing excessive damage to the body.

If we really get down to the finest details, every drug and every micro pump's infusion speed has its own particularities.

Lao He initially listened cautiously, but as time passed, he spoke more and more.

Zheng Lao Ban demands the most precise values, minimal surgical trauma, and minimal anesthetic impact.

Based on scientific calculations, Lao He combined his years of rich clinical experience and made certain modifications to the values Zheng Ren had explored in the System Operating Room.

Meanwhile, Zheng Ren discussed with Lao He, and after obtaining the values, he went to the System Operating Room to fetch experimental topics for research.

In this regard, Zheng Ren fully exploited the advantage of his cheat.

The dosage Lao He gave is merely the limit that an anesthesiologist with rich clinical experience can achieve; it's just an estimate, and specific adjustments still need to be made according to the intraoperative situation.

Zheng Ren, without hesitation, took Lao He's speculation to the System Operating Room for verification, and after coming out made even finer adjustments.

Regarding Zheng Lao Ban's 'deduction,' Lao He doesn't think anything is abnormal. In his view, Zheng Lao Ban has already maxed out the skill points for this deduction ability.

At the Women and Children's Hospital incident, involving much anesthesia coordination, whenever there was a difficulty, Zheng Lao Ban would enter a meditative state. However, this state didn't last long; he would wake up, simultaneously gaining new perspectives and viewpoints.

The facts proved that Zheng Lao Ban's suggestions were correct.

Lao He has always admired Zheng Lao Ban for this, so he simply took out pen and paper and meticulously recorded the results of Zheng Lao Ban's deduction.

This is what needs to be done intraoperatively.

'Boss, Surgical Training is ready!' Su Yun called out.

'Wait a moment, you go first; I still have things to discuss with Lao He.' Zheng Ren shook his head, still studying anesthesia with Lao He.

Lao He's A4 paper already had one and a half sheets written on.

Su Yun leaned over to listen a few sentences; the pipe vibration issue had already been resolved, and Boss and Lao He were discussing the ventilator's support values after starting ECMO assistance.

'It's still early; after discussing the ventilator, there's still the question of whether to proceed with extracorporeal circulation.'

Lung transplant is called a surgery, but the surgical technique isn't the most crucial. It focuses more on details; to succeed, from anesthesia to surgery to ICU critical care, every member of the overall team must exert their maximum effect.

Su Yun knew that in lung transplant surgery, the ventilator shifts from a device supporting oxygenation and ventilation to a tool for reducing systemic inflammatory response.

During ECMO flow, the lungs still provide a small portion of gas exchange, but the ventilation strategy mainly targets overdistension or collapse and injury. As dependence on the lungs during ECMO decreases, ventilator management shifts to a lung-protective strategy of reducing tidal volume to the ideal body weight.

Generally speaking, 6 ml/kg is a relatively ideal value. But Boss is not satisfied with this 'crude' theoretical value, still calculating with Lao He using cumbersome formulas. Moreover, this guy keeps 'acting foolish'; is his brain crashing?

This time even Su Yun looked dumbfounded.

Although low tidal volume is a standard lung-protective strategy, reducing lung driving pressure—that is, reducing the pressure difference between airway peak pressure and end-expiratory positive pressure—and preventing lung tissue collapse are both crucial for recovery.

Collapsed lungs require higher pressure to overcome atelectasis, which is to counteract the natural lag phenomenon when ventilation is insufficient. The resulting pressure increase and loss of surfactant will further exacerbate the inflammatory response.

These details have already gone beyond the realm of pure surgery, not belonging to anatomy but to physiology.

In the study of lung tissue, Boss is actually this meticulous, leaving the rising star of Di Du's Cardiothoracic Surgery wondering how they can endure it.

Su Yun felt quite helpless about this. He listened carefully for ten-odd minutes; the various cumbersome formula calculations and the values Lao He derived from years of rich clinical experience seemed to him a near-perfect anesthesia operation, yet Boss was utterly dissatisfied.

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

The reasoning Su Yun understands—since ECMO can directly deliver oxygen to the blood, the ventilator's inhaled oxygen concentration can be lowered to the minimum to avoid oxygen toxicity.

Although there is no conclusion yet on the optimal mode and exact target of the ventilator during ECMO assistance, the traditional oxygenation goal is a partial pressure of oxygen greater than 60 mmHg and oxygen saturation greater than 80%.

But the traditional… has been smashed to pieces by Boss.

After repeatedly making fine adjustments, Lao He's A4 paper is already filled with three pages.

'Boss, you guys research first; I'll take Lin Yuan and Xiao Ran to familiarize ourselves with the surgery.' Su Yun felt quite helpless; even after hearing all this, his head felt a bit swollen and uncomfortable.

As for Lao He, looking at that guy's state, he might faint outright after finishing the research.

Zheng Ren's research with Lao He is about done; he also expressed relative satisfaction with this. Anesthesia is fundamental, especially in double lung sequential transplant surgery under ECMO assistance.

Using the scheme developed together with Lao He, Zheng Ren entered the System Operating Room once again to begin surgical training.

Surgical completion rate improved by 3-4 percentage points; Zheng Ren felt quite happy.

But during the fifth surgical training, when Zheng Ren had just begun anastomosing the main bronchus, the experimental subject's respiratory circulation suddenly underwent a drastic change.

Zheng Ren was dumbfounded; the originally perfect process—where did the problem arise?!