Back to 1999: From operating surgeons to becoming a top doctor

The hypercapnia and high airway pressure mentioned by Xiao Chenguang are just the most common problems in anesthesia management for laparoscopic surgery.

As for other more complicated problems such as renal perfusion and decreased cardiac output, Xiao Chenguang did not mention them because this operation was not involved for the time being.

But at this moment, Liu Tie was so shocked that he could not speak.

Unlike the instrument nurse who seemed to be listening to a book of heaven, this was his profession, and he could naturally distinguish whether Xiao Chenguang was talking nonsense or had real skills.

Even through Xiao Chenguang's concise explanation, Liu Tie felt a sense of sudden enlightenment.

This was a feeling he had never had when he went to the provincial capital for further studies.

"Doctor Xiao, how should the patient's respiratory parameters be set?"

Liu Tie asked with a humble expression.

As soon as this was said, it was Wang Jingang's turn to be surprised.

He knew that Xiao Chenguang was very powerful, but he didn't know that he was so powerful.

In Wang Jingang's opinion, Liu Tie is already the backbone of the Anesthesiology Department of Shengli Hospital, and his knowledge and clinical experience are no worse than their department director.

That's why he had to let Liu Tie rush over from home late at night to take the stage.

But now.

He was actually respectfully asking Xiao Chenguang questions.

There was even a hint of humility in his attitude.

"In fact, parameter setting is very simple."

Seeing Liu Tie's correct attitude, Xiao Chenguang simply said: "First, calculate the tidal volume according to the patient's height and weight, then set the inspiratory pressure and positive end-expiratory pressure according to the strategy of lung protective ventilation, and finally adjust the respiratory rate through arterial blood gas analysis."

"Like the old man on the stage, due to a huge incisional hernia, the abdominal pressure is greater than that of a normal person. You can adjust the PC to 15cmH20, peep 5cmH20, inspiratory-expiratory ratio 1:2, and respiratory rate 20 times/minute."

Even Xiao Chenguang explained to Liu Tie clearly the values ​​that are not often touched, such as pressure rise time and trigger sensitivity.

Now, Liu Tie was completely convinced.

Many things that he had been confused about before, now after Xiao Chenguang's explanation, it seemed to open a brand new door for him.

Liu Tie nodded his head like a chicken pecking at rice in the face of the vast knowledge.

This made the nurse on the instrument table very happy.

She had been working with Liu Tie for so long, but when had she ever seen him so serious and eager to learn?

Doctor Xiao was really strong.

The worries that had originally shrouded their hearts had vanished without a trace.

"Xiao Xiao, the equipment has been installed, and the operation can begin." Wang Jingang pushed the debugged laparoscopic imaging system to the side of the table.

"Okay, Director." Xiao Chenguang nodded with a natural expression.

Eh?

The instrument nurse looked at the two of them in a daze, always feeling that something was wrong.

But she couldn't tell what was wrong.

Then the two washed their hands, put on surgical gowns, and stood on the operating table together.

Now the instrument nurse finally found out what was wrong.

"Director... Doctor Xiao, are you two standing in the wrong positions?"

Eh?

The two were startled at the same time, instinctively looked down to check, and suddenly became embarrassed.

In the operating room, Xiao Chenguang stood in the position of the main surgeon, while Wang Jingang stood in the position of the assistant.

The most important thing was that neither of them noticed it.

"That..." Wang Jingang's face was a little red. Even though he had worked for many years, he didn't know what to say at this moment.

"The standing position for laparoscopic surgery is different from that for traditional surgery." Xiao Chenguang said seriously.

"......" Wang Jingang.

"???" Liu Tie.

"Oh, oh, sorry, this is my first laparoscopic surgery. I'm so sorry, I didn't know." The instrument nurse looked flustered and apologized quickly.

"......"

......

"Xiao Xiao, how about it?"

"Director, let me hold the mirror."

Xiao Chenguang knew what Wang Jingang wanted to say, but he couldn't perform the surgery until his surgical authority was raised.

Moreover, in laparoscopic surgery, sometimes holding the mirror is more important than performing the surgery.

"Okay, I understand."

Wang Jingang was very conflicted. He had seen Xiao Chenguang's strength, but this damn authority...

Wang Jingang had already made a secret decision to apply for surgical authority from the hospital after this operation was completed.

By then, even if he had to slam the desk of the hospital leader, he would let Xiao Chenguang's surgical authority be upgraded to level four.

Even Wang Jingang has begun to consider Xiao Chenguang's leading the team.

Although he is young, he has good skills. With Xiao Chenguang's ability, it may be a bit unfair for him to be a deputy director.

However, Wang Jingang's current authority is only that of a department director, but if he can become the director of general surgery...

"Director, the patient's skin has been disinfected."

Xiao Chenguang is wearing surgical gloves, wipe the patient's entire abdomen with iodine gauze according to the standard for disinfection.

The range is from the xiphoid process to the upper 1/3 of the thigh, and from both sides to the posterior axillary line. After three disinfections, the range gradually narrows.

The patient's originally fair skin gradually turns dark brown, and it feels like paint is painted on the skin.

"Okay, prepare to establish pneumoperitoneum."

Wang Jingang's thoughts are pulled back to reality. As the scalpel is handed over, he begins to cut a 10mm skin incision at the lower edge of the umbilicus.

Then he uses his index finger to go deep into the incision and begins blunt separation, and soon the milky white peritoneal layer is revealed.

To be honest, for Wang Jingang, no matter how good the separator is, it can't beat his fingers.

This is the most common method used by the older generation of surgeons. After all, when they were young, the conditions were difficult, and there were no surgical instruments like now.

Over time, they are used to "knocking meat" with their fingers.

Xiao Chenguang watched the director skillfully digging and digging in the patient's small incision with his fingers, and couldn't help shaking his head helplessly.

Rough, too rough.

If this had happened twenty years later, he would have been scolded by his superiors.

But now it is 1999, and everything is going smoothly.

"The director is worthy of having studied laparoscopic surgery. He is very skilled in the selection and freeing of incisions."

Xiao Chenguang praised himself in a self-consoling way.

"Really? Although I don't do much laparoscopic surgery, I have been practicing with various substitutes in the operating room during that time."

Wang Jingang, who was in the operation, was very happy when he heard it.

It seemed that Xiao Chenguang's random praise was a recognition of him.

Xiao Chenguang: "..."

But the good times did not last long. When Wang Jingang was about to insert the pneumoperitoneum needle from the incision, he found that the patient's peritoneum was pushed out by the swollen intestinal tube.

The space left for him to puncture was very small. If he was not careful, he would puncture the intestinal wall and cause intestinal perforation.

Looking at the peritoneum as thin as a cicada's wing and the intestinal tube that was about to come out, Wang Jingang's hands trembled a little.

While hesitating, Xiao Chenguang's voice came at the right time.

"Director, how about I do it?"

"Okay."

Wang Jingang felt relieved and handed the pneumoperitoneum needle to Xiao Chenguang on the opposite side.

Although Wang Jingang had also inserted a peritoneal drainage tube, the procedures of the two were similar, but the pneumoperitoneum needle was thick and large, and he was a little bit out of control.

"It's quite handy."

Xiao Chenguang took the pneumoperitoneum needle and weighed it. Although the material was still inferior to the future, he could still feel the sharpness of the metal needle tip when holding it in his palm.

He took a look at the peritoneal incision, and the pneumoperitoneum needle in his hand tilted at a 45-degree angle to the abdominal wall. Without any hesitation, he pierced it with one needle.

The long pneumoperitoneum needle was shortened by half in an instant, which made Wang Jingang's eyelids jump.

Xiao Chenguang was really bold.

At this angle and this depth, if he didn't have absolute confidence, he might have penetrated the intestines with one needle.

But at this time, Xiao Chenguang was calm as water, and his hands did not slow down, and even faster and faster.

He pulled back the pneumoperitoneum needle core to ensure that the needle tip did not enter the blood vessel by mistake. Then he asked for saline solution, which was connected to the pneumoperitoneum needle. The saline solution in his hand flowed into the abdominal cavity.

"The puncture was successful. Connect the carbon dioxide inflator to increase the pressure and establish artificial pneumoperitoneum."

"The pneumoperitoneum machine has an air intake speed of 0.5L/min and a total volume of 2L. The intra-abdominal pressure is set to 12mmHg, and the total pressure does not exceed 2.13KPa."

Xiao Chenguang said calmly.