Chapter 3174: 2969 Starting to Direct from Anesthesia

After entering the operating room, Lao He took Xiao Shitou inside, while Zheng Ren and Su Yun went to change clothes.

"Boss, are you really planning to stay in the ICU for several days and nights?" Su Yun asked.

"Hmm." Zheng Ren said, "I'd rather go and look after him myself; you shouldn't leave either. Although our 912 ICU is strong, after all it's a 3D‑printed lung, anything could happen, and I don't feel at ease leaving them in charge."

Su Yun's lips twitched as she wanted to retort, but she held it back at the last moment.

Everyone else had already entered the operating room early to prepare; the medical team attached great importance to this surgery, to the point that even Gao Shaojie volunteered to help, canceling today's TIPS procedure.

Zheng Ren rejected that request, so Gao Shaojie had to team up with Zhou Chun Yong to perform the surgery, while the others had already arrived early at the Big External Operating Room and began preparations in the innermost Hybrid Operating Room.

The surgery had been prepared for a week, but when it was time to go on stage, Zheng Ren felt a bout of near‑home nervousness. After changing clothes in silence, Zheng Ren and Su Yun walked into the operating room.

Director Xu stood at the operating room door, saw Zheng Ren enter, and gave a wry smile, saying, "Boss Zheng, where did you find this circulating nurse?"

"Ah?" Zheng Ren thought Director Xu was going to ask if there was anything he could help with, but he never expected him to ask that.

"A foreign‑trained nurse." Su Yun replied promptly.

"He won't even let me in." Director Xu complained.

"Uh..." Zheng Ren was speechless. "Yesterday I told her to keep the number of people to a minimum to avoid breaking the sterile environment. Sorry, Director Xu."

"Boss Zheng, from now on you won't be bringing your own people with the circulating nurse, will you?" Director Xu said half‑jokingly, half‑seriously.

"I don't know." Zheng Ren was also quite puzzled about this.

"Director Lin said this is a foreign friend with considerable background." Director Xu asked quietly.

"Well, he should count as one of my patients."

While they were talking, the three of them came to the outside of the operating room. Marlis was preparing the various items needed for surgery; after a period of training and the past few days of adaptation, she had become as proficient as a regular nurse from the 912 ward.

Today Marlis wore an isolation gown; after a period of treatment, the fat on her lower body was removed, and she regained her proud figure—or, more accurately, she took on the figure that Ke Li had helped her customize.

Zheng Ren's cosmetic surgery had turned out very well; at a glance from behind, one might think a supermodel was bustling about in the operating room, with no trace of the former devilish figure whose lower half resembled a mountain of flesh and upper half a withered skeleton.

"Marlis, this is the leader here, Director Xu." Zheng Ren entered and first introduced her to Marlis.

Marlis turned her head and asked, "Leader? Yun Ge'er, what is that?"

Hearing her question, Su Yun furrowed her brows. The atmosphere grew a little awkward, and Zheng Ren felt that even a professor who constantly spouts big‑word nonsense would be preferable—at least a professor is a doctor who knows the operating room's rules and would never clash with those managing it.

"Can he come in?" Marlis also sensed the awkwardness and then asked.

"Come in..." Zheng Ren said, "Director Xu, do you have time to lend a hand?"

"Yes." Director Xu's voice sounded dry; here in the 912 operating room, he actually needed permission just to enter—how absurd! If it weren't for Boss Zheng's request, he would surely have blown his top.

"Thank you for the trouble." Zheng Ren said.

"Zheng, is anyone else coming?" Marlis asked earnestly and persistently, "Too many people entering is bad for sterility, as the book says."

"Dr. Charles will be coming shortly, and after that there'll be no one else." Zheng Ren said helplessly.

Zheng Ren exchanged a few words with Xiao Shitou, then turned his gaze to Lao He.

Lao He had already prepared everything; he nodded and got ready to administer anesthesia.

"Wait a moment, I'll go scrub first." Zheng Ren said, "I'll be in charge of this surgery from start to finish."

Regarding Boss Zheng's strange request, Lao He didn't say anything—twenty‑plus pages of A4 paper wouldn't be enough, and for Boss Zheng to insist on directing from the beginning seems overly cautious.

Sometimes Lao He felt that Boss Zheng treated this little patient differently and better than he did others.

Zheng Ren strode out to scrub his hands, then returned, put on his clothes, and the song "Good Luck Come" was already playing softly, serving more as background music.

Dr. Charles arrived just as the surgery was beginning, with Lin Ge accompanying him and explaining the 912 operating room.

Zheng Ren squinted and smiled, but didn't chat much with the doctor.

"Radial artery puncture, do a blood gas analysis, and keep a sample." Zheng Ren, having put on his clothes, said from the corner.

Lao He and his assistant began the procedure swiftly, while Su Yun, Lin Yuan, and Gu Xiao Ran had already started laying out the sterile drapes, preparing for ECMO cannulation.

"Midazolam 1 mg, etomidate 0.15 mg/kg; sufentanil 0.15 mg/kg, rocuronium bromide 0.12 mg/kg." Zheng Ren said in a low voice.

These dosages were the result of several days of discussion with Lao He, plus Zheng Ren's hundreds of trials in the System Operating Room—so well‑known they were second nature. Yet Zheng Ren remained cautious as he took over surgical command for the first time, not relinquishing control of anesthesia.

Lao He began administering the drugs; after muscle relaxation he performed endotracheal intubation, connected the ventilator for mechanical ventilation, and selected a left‑sided double‑lumen bronchial tube for the airway.

Zheng Ren also set the ventilator parameters, then started an intravenous infusion of propofol 0.02 nag/kg/min and vecuronium bromide 1 µg/kg/min, with intermittent boluses of sufentanil.

Once the anesthesia took effect, Su Yun brought Lin Yuan to start ECMO.

The right femoral artery and vein were cannulated: the artery with a 15 Fr catheter advanced to the level of the common iliac artery, the vein with a 19 Fr catheter advanced to the inferior vena cava. A heparin‑coated membrane lung and tubing, a heat exchanger, a centrifugal pump head, and an oxygenator were selected.

After the catheters were in place, flow was initiated immediately, with an initial flow rate of 2.5 L·min⁻¹·m⁻² of intermittent cardiac output, maintained above 30 % during the transfer.

Seeing Xiao Shitou's vital signs stable and his oxygen saturation steadily rising, Zheng Ren began laying out the sterile drapes and prepared for surgery.

The operating room was quiet, with only the song "Good Luck Come" drifting in the air.

After completing preoperative preparations, Zheng Ren took the surgeon's position, mentally reviewed the well‑practiced procedure, and, having readied the electrocautery and suction device, reached out.

The hemostatic forceps clamped the iodine‑soaked gauze, which landed in Zheng Ren's hand.

After disinfection, he made an incision, taking a bilateral anterolateral thoracotomy plus a sternotomy. The incision ran through the fourth or fifth intercostal space on each side, from the mid‑axillary line to the sternal edge, then across the sternum.

This incision provides ample exposure of both pleural cavities from the pleural dome to the diaphragm and the posterior mediastinum, making it easy to mobilize the lungs and pulmonary hilum. Although some have recently advocated avoiding sternal division, Zheng Ren, after surgical experimentation, still chose the most "old‑fashioned" approach.

Although this method causes slightly more trauma, the operative time is markedly shortened, making it more suitable for Xiao Shitou.

"Boss, are you nervous?" Su Yun stood opposite Zheng Ren, sensing a heavy atmosphere in the operating room, and asked with a chuckle.

"Not bad." Zheng Ren's eyes narrowed as he replied with a smile.