Chapter 185: Anesthesiologist, another adventure of the most stable scalpel
Giving the patient an anesthetic injection and implementing local anesthesia, or putting the patient into a coma, commonly known as general anesthesia, is just the most basic and simplest job of an anesthesiologist.
The technical content is not high.
Anesthesiologists are truly respected as guardians of life because they can provide patients with various life support.
Various crises can be predicted in advance, so that the safety of the entire perioperative period is under their control.
Accidents may occur during the operation, such as the patient having allergic reactions, cardiac arrest, respiratory failure, sudden drop in blood pressure, or a sharp drop in blood oxygen... They need to provide solutions to any problems related to vital signs that the patient encounters during the operation as soon as possible.
If the patient has cardiac arrest, CPR must be performed immediately.
If ventricular fibrillation occurs, electric shock defibrillation is necessary.
From this, we can see that in addition to anesthesia, the work of anesthesiologists is also responsible for whether the operation can be carried out and the safety of the patient during the operation. They need to control the patient's vital signs during the operation to ensure that the patient can successfully complete the operation under painless and safe conditions.
If you just give anesthesia to the patient, you are not called an anesthesiologist, but an anesthesiologist of a medical beauty institution.
Why do accidents often happen in medical beauty institutions? People die from time to time.
Because they only have anesthesiologists, not anesthesiologists.
Many people cannot distinguish between an anesthesiologist and anesthesiologist. After this comparison, they should be able to clearly distinguish the difference between the two.
Next time when I go for plastic surgery, I will not easily put my life in the hands of fake doctors who only know how to use anesthetics.
Those anesthesiologists, no matter how high-profile they are packaged or how much they brag.
They are technicians, not doctors.
Anesthesiologists in regular hospitals have medical practice certificates and physician qualification certificates, have the right to prescribe, and can participate in surgery.
Anesthesiologists are much more senior than anesthesiologists.
Doctor Feng looked to be in his 50s, and he was only seen during extremely difficult level 4 surgeries. Zhou Can secretly guessed that Doctor Feng was most likely a chief physician.
He helped Dr. Feng and never thought about anything in return.
Unexpectedly, Dr. Feng suddenly taught him some advanced knowledge of anesthesia.
It was a pleasant surprise.
Zhou Can listened humbly to his anesthesia experience and even wrote down some key points of knowledge in a notebook.
A good memory is not as good as a bad pen.
Sometimes a surgery requires a lot of notes, even what kind of sutures are needed to suture organs and peritoneum, Zhou Can writes them down in a notebook. Surgery is related to the life and safety of the patient, and a small suture can sometimes lead to the failure of the operation.
This is by no means an exaggeration.
There is no exaggeration.
For example, when suturing organs or tissues that are under greater tension, thinner sutures are used.
The patient just sneezed after the operation, that’s not too much, right?
Then the sewn parts broke.
If it is on the surface of the body, it is not bad. If it can be discovered in time, just sew it again.
If the surgical wounds in the abdominal or thoracic cavity rupture, wouldn’t that be the end of us?
"Do you know what disease the patient has?"
Doctor Feng asked.
"Thymoma!"
Zhou Can was ashamed that he knew very little about the patient's condition, because he belonged to Director Xueyan's group and was only familiar with the conditions of the patients in this group.
For patients in other groups, there is rarely an opportunity to understand.
"Before performing anesthesia, it is necessary to consider the patient's disease and physical condition, and comprehensively consider the patient's body position and anesthesia plan. For example, this patient has myasthenia gravis, so he needs to lie in a supine position before the operation, and a thin pillow should be placed on his shoulders and back. For patients with myasthenia gravis, an effective therapeutic dose of anticholinesterase drugs should be formulated..."
Although Dr. Feng has a somewhat eccentric personality, the valuable experiences he taught Zhou Can are all practical stuff.
Zhou Can studied humbly and recorded the key points in his notebook.
Not long after the patient underwent endotracheal intubation and general anesthesia, Director Le and Director Hu Kan arrived.
When it comes to inserting a urinary catheter into a patient, Zhou Can is the perfect person to do it.
I just did it easily.
Earned another 1 point of placement experience.
"Doctor Feng, is the patient in good condition?"
Director Hu asked about the patient's condition and asked the nurse to help him put on sterile gloves.
"It can be operated on."
Doctor Feng is really frugal with words.
Even when dealing with the most capable chief physician in cardiothoracic surgery, his tone was cold and indifferent, with no smile on his face.
I heard that the longer an anesthesiologist works, the quieter he or she becomes.
Because their nerves are always in a highly tense state, the nature of their work does not allow them to chat with others.
From this point of view, the importance of the anesthesiologist is as important as that of the surgeon.
The annual income of anesthesiologists in the United States is on par with that of surgeons.
However, in China, anesthesiologists face various difficulties. The income is not low. The basic salary of an attending anesthesiologist plus various performance and overtime pay is about 20,000 yuan. Add in the year-end bonus, and it can reach more than 30,000 yuan.
But this is what they paid for with their lives.
According to statistics, among the 29 doctors who died suddenly, 14 were anesthesiologists.
These anesthesiologists who died suddenly were all strong young men, the oldest of whom was no older than 40 years old.
From this death data, it can be seen that the workload of anesthesiologists is seriously overloaded.
It is common to receive a call in the middle of the night and rush to the hospital to administer anesthesia to a patient undergoing emergency surgery.
In addition to the tiring work, it is also very difficult for anesthesiologists to be promoted. It is extremely difficult to be promoted to a senior position.
Another thing is that they basically work behind the scenes, and no matter how successful an operation is, their fame will hardly change.
They work silently behind the scenes, bear more pressure than the chief surgeon, have a heavy workload, and their work is as important as the chief surgeon's. However, the difference in treatment is huge.
Anyone would feel psychologically unbalanced.
It is precisely these unfair treatments that have led to a perennial shortage of anesthesiologists.
Even many medical schools do not offer the major of anesthesiology.
This is an issue that deserves deep thought in the domestic medical community.
Only by changing the status and treatment of anesthesiologists can more medical students be willing to apply for the anesthesiology major.
Otherwise, the problem of staff shortage in the anesthesiology department will only become more serious.
Relying on leaders to trick newbies into joining the anesthesiology department is not a solution after all.
Director Hu Kan checked the marked incision sites and tumor locations on the patient's body, verified them one by one, and started the operation.
A midline sternotomy was performed to complete the thoracotomy.
Compared with the open-chest surgery performed by Xueyan, Director Hu Kan's steady and step-by-step approach during the operation gave people a particularly safe feeling.
Over the years, Director Hu Kan has never had any safety accidents, which is enough to explain everything.
After opening the chest, the pleura is folded back and pushed to both sides.
At this time, the thymus tissue located in the anterior mediastinum can finally be seen.
Zhou Can had a bad feeling after just one look.
This patient's thymoma had unclear boundaries, the wrong color, and was adherent and infiltrated to the surrounding areas.
It can be seen that the adjacent tissues and organs are obviously displaced by the tumor.
"This is undoubtedly a malignant tumor!"
Zhou Can's heart sank slightly. The difficulty of today's operation would increase several times.
Malignant tumors often lead to changes in anatomical relationships.
There are many uncontrollable risks during the resection process.
After seeing the situation of the thymic tumor, Director Hu Kan, who had seen countless big scenes and experienced countless difficult operations, could not help but feel scared at this moment.
The disease is too powerful.
The patient's body has been destroyed beyond recognition.
Completely removing a tumor requires a lot of experience and skills from the doctor.
"It's ok that the fibrous connective tissue is just sticking together like this, but it's obviously thickened a lot. The risk of surgery is too high."
After reading it, Director Le shook his head.
If you ask him to cut it, he would never dare to do it.
"We have to do it no matter how high the risk is! We have done an assessment and discussion before the operation. We can't just sew up the patient's chest just because the situation is not good, right?"
Director Hu Kan's tone was full of helplessness.
In his decades of surgical career, he has encountered countless difficult surgeries.
Which time is without risk?
In the end, he managed to get through successfully.
This time, he believed that he would be able to successfully complete the operation. This confidence came from his decades of successful experience and decades of hard practice.
He would practice stability every day, rain or shine, including the stability and coordination of his arms, as well as his concentration.
Long-term meditation also brought him another unexpected benefit, which is concentration and peace of mind.
Many people think that Buddhist meditation and Taoist meditation are superstitious activities, but this is not true. Their respect for the Buddha or the Taoist is not superstition, but a kind of belief.
Superstition and faith are actually two completely different concepts.
It is a terrible thing if the faith of a person, a nation, or even a country collapses.
There have been hundreds of schools of thought in Chinese history, but after thousands of years of verification, it has been finally proved that only Taoism can make a country prosperous. Confucianism and Legalism can only govern a country, but cannot make a country prosperous and strong.
In the course of history, even today, Taoist thought still has a profound influence on China.
Why are both Confucianism and Legalism not good? Because Legalism is harsh and cruel, and inhumane. Confucianism only talks about reason, and in the end, the First Emperor was the first to teach Confucianism how to be a man. Burning books and burying scholars was not a joke, it was real killing.
If you only talk about principles but don't have strong fists, can you build a country?
There is a classic saying in Taoism that is still regarded as a guideline for hospitality by the Chinese nation: When friends come, we have good wine; when jackals come, we have swords.
China still adheres to the Taoist principle of treating others with courtesy before force.
Director Hu Kan insists on sitting quietly every day, which can be regarded as a Buddhist meditation or a Taoist meditation. Over time, his heart becomes more peaceful and his concentration becomes stronger.
This is an important support for stabilizing the knife.
It can make him as steady as an old dog and not panic when encountering difficulties.
As long as you stay calm and maintain your composure at all times, you will be able to calmly resolve dangerous situations during surgery.
"Now that the thymoma has appeared, we should do our best to deal with it. Director Le, you will lift up the lower pole of the thymoma."
This task was given to the assistant so that he could concentrate on separating the thymoma from the surrounding tissue.
Zhou Can stood under the operating table, watching Director Hu Kan operate the high-frequency electrosurgical knife, separating the thymoma from the surrounding fat tissue one by one. He carefully separated the thymoma from the bottom to the top.
"What a great separation technique, and such a steady knife."
Zhou Can was secretly envious. He thought that if one day he could also practice the separation and incision techniques to this level, it would be amazing.
In addition to his superb technique and steady knife, Director Hu Kan's concentration is also terrifying.
The cutting is like a god, and the amount of separation, depth, width, and even speed of each cut, as well as the avoidance of surrounding blood vessels and nerves, are all breathtaking.
Even the Da Vinci robot probably doesn't have such high accuracy.
Although many doctors are in awe of robotic surgery and manufacturers are desperately promoting it, the actual effectiveness of the surgery remains to be discussed.
Manufacturers tout robotic surgery as a three-dimensional imaging device that can magnify the field of view by 6 to 10 times. The robotic arm has a high degree of freedom in operation and can rotate 540 degrees, allowing it to drill into the abdominal and thoracic cavities like Sun Wukong and cut off everything that needs to be cut.
But in fact, in addition to its high cost, it also lacks tactile feedback and has the risk of various accidents.
The gap between it and an excellent surgeon is actually very large.
Robotic surgery may never replace surgeons.
On the one hand, the development of artificial intelligence is still far from perfect. On the other hand, the combination of human thinking and emotion makes the surgery full of warmth and can quickly and flexibly adjust to various ever-changing surgical scenes.
There is also tactile feedback.
The human skin and nervous system form an extremely complex and sensitive tactile system.
A skilled surgeon will get different hand feedback when cutting different tissues, and will be able to detect any abnormalities immediately.
A robot is just a cold machine with program settings. Even though it is manually controlled remotely, it may cut something that it shouldn't cut, and the person who controls it has no way of sensing it immediately.
Robotic surgery, which seems to be extremely precise, flexible, and has relatively few complications, has not been accepted by patients, and it is not just because of the high cost.
Director Hu Kan's movements were steady and slow. He was very focused during the operation, and Zhou Can also watched attentively.
Learn his steady knife style and draw strengths from it.
Then integrate it into your own sharp knife.
Zhou Can likes to think and ponder. Some advantages are in opposition to his quick-sword style. How to integrate them requires hard thinking and integration little by little through repeated practice.
"laugh!"
A very slight abnormal sound was heard from the patient's chest.
This is definitely not the sound of a high-frequency electric knife, nor is it the sound that should be made when cutting body tissue.
Zhou Can's heart tightened, and then he saw blood spurting out.
The closer to the heart, the higher the pressure in the blood vessels.
Once an artery ruptures, the effect of using a water gun will appear.
The expressions of the others also became solemn, and they stared closely at the patient's chest.
The god in their minds must have accidentally injured an artery.
This is not a failed operation, it's just an accident.
"The fibrous connective tissue has been adhered and thickened, making it extremely difficult to distinguish it from the blood vessels, causing accidental injury. It's okay, stop the bleeding quickly." Director Hu Kan said to stabilize the morale of the troops.
His surgical team is also extremely good.
The second assistant immediately clamped the ruptured blood vessel to stop the bleeding.
If the blood spurts out like a water gun, the ruptured blood vessels are definitely not small ones. This is considered heavy bleeding.
Although Director Hu Kan is very calm, if the bleeding cannot be stopped in time, it will pose a serious threat to the patient's life.
"Do you think we should tie off this blood vessel first, and then repair it after the separation is complete? Or what do you think?"
The second assistant is also very powerful.
From the precise clamping he used just now to stop the bleeding, his calm, quick and accurate movements, it can be seen that his level of hemostasis is extremely high.
Even though Zhou Can's hemostasis skills had reached an average level among medical specialists, he was still inferior to them.
"Get the ligation first!"
Director Hu Kan hesitated for a moment before answering.
Accidentally cutting such a large artery would definitely cause some psychological distress to Director Hu Kan.
He didn't say anything and didn't show it on his face, but his heart was already in turmoil.
Having strong concentration and deep calmness does not mean that you can remain calm no matter what happens.
The most he can do is stay calm, just like he is now.
Zhou Can looked at the artery, moved his lips, but ultimately said nothing.
The second assistant signaled to the third assistant, who stepped forward and used a skillful technique to quickly ligate the proximal end of the artery, temporarily stopping the bleeding.
As for repairing this artery, we can only wait until the separation is completed and the thymoma is completely removed.
The operation continues.
Less than twenty minutes later, Dr. Feng said in a very puzzled tone, "The blood oxygen saturation has dropped!"
At first glance, that’s right!
Normal blood oxygen saturation is between 95% and 100%.
Usually it is above 99%.
At this moment, the patient's blood oxygen saturation has dropped to 91%, approaching the warning threshold.
Zhou Can worked in the Department of Critical Care Medicine for three months, dealing with critically ill patients in the intensive care unit every day, so he was very sensitive to blood oxygen saturation.
In the intensive care unit, if a patient does not urinate for two days, there is a high probability that the patient will die.
If the patient's blood oxygen saturation is not stable and keeps dropping, the patient may die if he is not careful .
So, right now the blood oxygen saturation of this surgical patient has dropped to 91%, and he is very aware of the danger.
Doctor Feng has extensive experience in anesthesia and must have sensed the danger, which is why he used such a serious tone to remind the surgeon, Director Hu Kan.
"Can adding oxygen raise the blood oxygen saturation by one liter? The separation surgery is less than halfway done, and it will probably take some time."
Director Hu Kan's eyebrows were slightly wrinkled; his energy was limited.
What I want now is to remove the thymoma as soon as possible, and then deal with the artery.
