Seven Hundred and Eighty Fourth Chapter Experience to Do

beep - beep -

The monitor in the operating room screamed monotonously, like a choked duck asking for debt.

Su Jiafu sat obediently on the round stool, looking at the value on the monitor for a while, and looking at the operation of his director for a while, like a choked duck trying to avoid debt.

"When propofol and remifentanil are used in combination, the dosage of propofol can be reduced, which can also shorten the postoperative recovery time of the patient..." The director of the anesthesiology department also said a few words to Su Jiafu while operating.

Ling Ran is used to using Su Jiafu as the anesthetist, and the cooperation between the two is also good, but to improve the prognosis of surgery in all aspects, especially to reduce the recovery time, a good anesthetist is very important.

Su Jiafu is considered a good anesthesiologist, but his skill tree climbed too low. When it came time to strive for excellence, he could only invite senior doctors from the anesthesiology department to come forward.

After the consultation in the anesthesiology department, they also came up with the most suitable anesthesia plan and adopted total intravenous anesthesia.

Compared with sevoflurane, which is commonly used in the whole process of inhalational anesthesia, remifentanil, which is commonly used in total intravenous anesthesia, has faster recovery, shorter action time, and no savings. Compared with the two, the probability of postoperative cognitive impairment is also lower when total intravenous anesthesia is used.

Postoperative cognitive impairment is a common complication after general anesthesia. Once it occurs, the patient's thinking ability, attention and language ability may have short-term impairment, and a few people may even have long-term impairment.

Of course, the probability of long-term impairment is very low, and postoperative cognitive impairment mainly occurs among elderly patients. In addition, the higher the education level of patients, the lower the probability of postoperative cognitive impairment.

As far as the working status of the patient Chen Xiaowang is concerned, even a short period of cognitive impairment may be unbearable. The Department of Anesthesiology was named by Huo Congjun. , The choice of the program is considered in many aspects.

People who are underestimated by Huo Congjun will be sprayed by him if they are not good, and they will be sprayed with contempt. As the department director of the anesthesiology department, he can't bear this kind of punishment.

The director kept watching the stable data on the monitor, and then watched Su Jiafu fill out the form on the computer, then pointed to the dosage of various medicines, and said, "I'll do it next time, and I have to have a count in my heart, don't just count foolishly." Like this cisatracurium, if you use it during induction, you have to control the dosage. For dexmedetomidine, you should pay more attention. If you use too much, you will have hypotension and bradycardia..."

Su Jiafu listened obediently, like a puppy being trained.

For Su Jiafu, who is still a resident, it is a rare opportunity to be trained as a director.

The anesthesiology department is busier than ordinary professional departments. If doctors in other departments have reached the director level, there is still a little room for relaxation, but the department director of the anesthesiology department often has to work on the front line.

The so-called only minor surgery, no minor anesthesia, once the department director of the anesthesiology department is in the battle, he has to do things seriously, it is not easy, and the department cleans up newcomers every year, unless someone asks for it, the director usually ignores it.

It can be said that the growth of a doctor is ultimately due to coincidence. Similarly, it is also very metaphysical for two new resident doctors to learn what level of doctor they can get. In many cases, it is not the performance of the new resident, but the attitude and busyness of the superior doctor.

Su Jiafu didn't have the opportunity to listen to the director's lectures before, but now that he has the opportunity, he naturally cherishes it.

Similarly, Lu Wenbin and Ma Yanlin in front of the operating table were also performing the operation with serious faces.

They could all see that Ling Ran's approach today was very different.

Surgeons are often rough when performing operations. The more professional the doctor, the rougher they are sometimes. It's like raising a child. Parents who bring their first child are really patient and worried about the child. Seeing him turn over will be nervous and his arms will be crushed. However, the attitude of the parents of the second child and the parents of the third child,

Definitely not the same.

General surgeons, when performing the first appendix operation, or the first cholecystectomy, are absolutely trembling, afraid of making mistakes-of course, they will definitely make mistakes.

However, when the 10th and 20th cases are performed, some habitual rough operations and illegal operations will start to appear. When the 100th operation is performed, the surgeon has formed his own routine and formed His own rough method. It's like a semi-new driver who has been driving for two years. He operates like a tiger in one pass, and then it is all blind operation.

In contrast, Ling Ran has always been strict and demanding, but not to the point of being critical.

After all, the human body is different, and it is meaningless to emphasize a uniform value, or stick to a specific red line.

However, Ling Ran's requirements today are extremely high.

Even the output frequency of the ultrasonic knife was adjusted and changed constantly, which made Lu Wenbin and Ma Yanlin not aware of it.

Ling Ran was still in the state of not saying a word. To be honest, what he could say, he had already said it during the pre-operative consultation. His current operation was completely out of trial.

The ultrasonic knife is a medical device that relies on high-frequency vibration to complete cutting and coagulation. To some extent, this kind of knife head with a maximum frequency of more than 50,000 HZ is already quite a black technology.

The greater its energy output, the stronger the cutting ability, and the lower the energy output, the weaker the cutting ability, but the stronger the coagulation and hemostasis ability.

For the same doctor, an operation with an ultrasonic scalpel is more than one-third faster than an operation with an electric scalpel, and the effect will be even better.

Among other things, the same is to stop bleeding, which can be done in 1 second with an ultrasonic scalpel, but 5 seconds with an electric scalpel.

And during the extra 4 seconds, the electric knife has been leaning against the tissue, and the damage will definitely be more.

The ultrasonic knife will also be damaged, so Ling Ran has to choose the appropriate frequency and time, which can complete the cutting and coagulation without damaging the tissue.

Even the angle of the titanium clip is specially adjusted and tested.

When the abdomen is closed, the bile duct and other tissues will be squeezed together. Coupled with the natural peristalsis of the body, if the titanium clip is not placed well, complications will easily occur.

However, these are all low-probability events. If it wasn't for the patient Chen Xiaowang's request, it would not have been so detailed.

But from another perspective, it was his request that gave Ling Ran a template and a goal.

Clinical medicine, in many ways, has no concrete data. The energy of the ultrasonic scalpel should be lowered a little, how low should it be? Pay attention to the placement of the titanium clip, what is the specific angle? There are no formulas.

The value of surgeons is often reflected in this.

The experience of a surgeon is accumulated through countless operations and thinking. Following the correct steps and doing the correct operation, the success rate will increase over time.

In contrast, evidence-based medicine has been developed to this day, and it is still a baby. It is impossible to be evidence-based in every step.

But it is possible for a surgeon to be a good patient, follow the model of a patient, and do more and better.

Maybe it won't change the world forever.

But it will make the world more hopeful and better.

...

Flying to the capital again, the "Internet Literature +" conference asked me to come and sing a song...