You must know that there are at least two foundations for the development of surgery.

One is asepsis and the other is anesthesia.

Asepsis can greatly reduce infections during and after surgery, and anesthesia is a basic guarantee for surgical operations.

Who dares to operate on a patient without anesthesia?

After doing this, I'm afraid the surgeon will be killed by the patient when he gets off the stage. Doesn't it hurt?

Therefore, in the case of pain, the patient will have a particularly extreme reaction. Once such a reaction occurs, the patient is in pain, and the surgeon's inability to get the patient to cooperate after the reaction is also a reason.

The patient is moving, and the surgeon is also moving. How do you determine where your surgery is?

When Quner heard this, he rushed over. While increasing the amount of anesthetic, he pinched the patient and asked, "Does it hurt?"

"It hurts, it hurts, it hurts so much." The patient was almost crying at this time.

If a knife is stabbed into a living person, will this help?

Hearing what the patient said, Cao Mengda was a little confused and said: "Anesthesiologist? Your shoulder joint patients usually receive brachial plexus block, don't they receive general anesthesia?"

Generally speaking, brachial plexus block is more troublesome than general anesthesia. Of course, if done well, the effect will definitely be very good, and the cost to the patient is also low. However, it is not as convenient and fast as general anesthesia, and the effect of anesthesia may not be as good as that of general anesthesia.

It's also relatively inferior.

Quner felt a little embarrassed when asked this question. He did not explain anything more, but continued to increase the amount of anesthetic.

Liu Deqian quickly explained: "Professor Cao, this is Director Qu Naqu, an anesthesiologist in our orthopedic department. Usually when we encounter shoulder arthroscopy surgery, other doctors use general anesthesia, but Director Qu

You can give us nerve block anesthesia!"

"You also know that after nerve block anesthesia, the patient's local pain will be greatly reduced, which will be more conducive to postoperative recovery."

Qu Na and Lin Zixiang's skills are the same. They are both well-known in the Changshi First People's Hospital. Moreover, Liu Deqian personally invited him to set up the stage for Professor Cao Mengda. Therefore, he must not sell his teammates at this time.

Cao Mengda nodded and continued to press the patient's wound without saying anything more.

It just seems that after Qunar added the nerve block drug to a certain level, the patient still felt a slight pain in the wound.

Suddenly, Qu Na's heart sank, and he began to worry about it. He said: "Director Liu, Professor Cao, this patient may be intolerant to anesthetic drugs. Please wait for me for a while, and I will change to general anesthesia immediately."

In terms of anesthesia, thorough preparations have been made before the operation. The intravenous channel has been established and can be changed to general anesthesia at any time.

Moreover, Quner had already pumped out the drugs, so after turning on the switch of the intravenous infusion pump, he pushed the general anesthesia drugs into the patient's blood vessels.

The patient gradually falls asleep!

After this, Cao Mengda and Liu Deqian continued to operate.

After opening the opening, it must be expanded. Changshi First People's Hospital certainly does not have a special opening expander, so Cao Mengda could only use straight pliers.

However, as soon as he opened his mouth, the patient's arm immediately twitched slightly.

Although the arc is not very large, it also means that the patient still feels pain at this moment.

It's just that he has been numbed and seems to be in a deep sleep.

Seeing this, Cao Mengda immediately stopped the operation, and then said: "Director Qu, this patient is probably very intolerant to anesthesia-related drugs. Now that the incisions have been made, is there anything else you can do?"

Once the operation starts, it doesn't mean that it can be stopped by shouting "stop". Now, after a hole has been poked in the patient's body, do we need to tell the patient, "Let's end the operation? Are you not sensitive to anesthetic drugs?"

Of course, if you end up with the same situation after trying all kinds of solutions, you still have to say this. But before you get to that step, you should still try to find a way to solve the problem.

Quner quickly looked at the patient's condition and then touched the back of his head.

Said: "This kind of person is quite rare. When I was in a meeting before, I heard a colleague from Guangdong Province or Sichuan Province introduce a similar situation. There are only occasional records in the literature."

"Professor Cao, the drugs I am taking now are already the best drugs our hospital can currently provide. I can add some more drugs, but the effect will not be much deeper, so I may just increase the dosage."

"But within a unit of time, the amount of drugs our body can tolerate is limited. I want to see the limit of the amount of drugs the patient can tolerate for pain."

"In this operation, the patient may wake up naturally in a very short time."

Anesthetic drugs produce anesthetic effects on the human body through central nerve block, but it is not ruled out that a very small number of people are not cold to it.

Just like Journey to the West is a classic in China, it does not rule out that among the more than one billion people in the country, there are three or four who want to call it a bad TV series. There is no way.

Next, Qunar determined the maximum amount of drug that could produce an anesthetic effect on the patient through the pain response. He frowned and said, "Professor Cao, based on the current drug concentration and infusion rate, this anesthesia can only

It can last for more than forty minutes. If it goes any higher, the patient will probably suffer drug-induced nerve damage."

"Do you think it can be done in such a short time?"

"If it really doesn't work, then we should do the surgeries separately, or not do it at all. Transfer it to a higher-level hospital and do it again?"

The amount of surgery scheduled for this patient is to start on the shoulder joint and knee joint at the same time. If both operations are completed, it will definitely not take more than 40 minutes.

But anesthesia can only last so long, so you have to make a choice!

Although it is very uncomfortable to explain to the patient after the operation is stopped midway, and it is also a blow to the reputation of the surgeon, the operation has not completely started yet, and the incision has just been made. There is still time, but there is still a possibility of being hurt by the patient.

Report it to your family.

This situation is an unexpected and uncontrollable situation. No one would give anesthetics to the patient for skin testing or testing, so no one could predict that the patient would be so intolerant of anesthesia.

After Professor Cao Mengda listened, he immediately said: "Director Liu, with the help of a more skilled assistant, I can finish the rotator cuff suture in forty minutes, but the meniscus suture, you see, is

Should we do it this time or postpone it to the next time?”

"If you can handle it yourself, we can do it separately."

Liu Deqian's expression changed slightly at that time. To be honest, he had to complete the cleaning of the knee joint and the suturing of the meniscus in more than forty minutes, and he felt unsure.

And Liu Deqian has another such candidate in his mind, that is Chen Bing, who can probably complete the suturing operation in such a short time. However, it would be too embarrassing to ask Chen Bing to go to the operating room at this time. .

So Liu Deqian didn't speak for a while.

Professor Cao Mengda said: "Director Liu, time is urgent. We still have to make a decision quickly. If we delay for one minute here, we will lose one minute later."

Liu Deqian said: "Professor Cao, I'm going to make a phone call and we will perform the surgery separately."

Although Liu Deqian felt that it was embarrassing and humiliating for him to ask Chen Bing for help, as a doctor, he could not forget the basic principle that he could not joke about the patient's condition and treatment process.

He called Chen Bing quickly, and then quickly explained what happened in the operating room.

Chen Bing immediately replied "Hello" and then hung up the phone.

Liu Deqian then returned to the operating table and said: "Professor Cao, Director Chen of our department is also a very skilled sports medicine doctor, so I plan to ask him to do the suturing, and I will do the rotator cuff suturing for you."

Cao Mengda nodded and said to the anesthesiologist without any hesitation: "Thank you for your hard work, Director Qu. We'll start right away."

"Here comes the muff!"

In order to save time, Cao Mengda did not plan to do the shoulder joint exploration step by step this time. Instead, he wanted to do the rotator cuff directly in one step and put the sleeve on directly.

This was also an extremely bold time-saving operation that he thought of after seeing Lu Cheng do it yesterday.

Cao Mengda just put the sleeve on, and Chen Bing and Lu Cheng went down to the operating room and quickly washed their hands.

When I got to the stage, I put on my clothes directly and without saying anything else, I asked: "Tour, has the second set of arthroscopic instruments been opened?"

"Director Chen, the equipment has been picked up, but you guys came too quickly, so the equipment hasn't arrived yet." The person who answered was not the patrol nurse, but the handwashing nurse.

"Okay!" Chen Bing responded lightly, and immediately asked someone to lift their legs, and he began to disinfect.

The previous plan was to separate the patients for surgery, so the knee joints were not disinfected. At this time, Cao Mengda and others had already started the main event of shoulder arthroscopy, so there was no time to disinfect the knee joints.

This did not leave much time for Chen Bing to perform the operation.

After Lu Cheng came on stage, Chen Bing winked at him and told him to help Cao Mengda.

This is not the time to vent your anger at all. Chen Bing is the director. If Liu Deqian has a medical accident, he will also be jointly and severally liable. Moreover, the struggle in the department can never be shelved on the patient. This is the last bottom line for a doctor.

Liu Deqian can make this call, but Chen Bing cannot be too selfish.

Just after putting on the sleeve, Cao Mengda discovered that things were not that simple. Because he was too reckless in the process of putting on the sleeve, so in terms of subsequent vision, he did not do a microscopic examination first and then put on the sleeve. broad.

This has caused quite a lot of trouble for Cao Mengda in determining the location of the upper outer row nails and finding the location of the rotator cuff injury.

Seeing this scene, Lu Chengcheng came to Cao Mengda's side and lowered his voice: "Professor Cao, why don't you try moving the hook upwards and back a little bit."

This is an injury to the supraspinatus, which is the most classic injury site in rotator cuff injuries. But although it is a classic injury site, it is not the common H/I-shaped classic injury, but an oblique shape. Semi-damaged, the continuity is not completely broken, so there are certain difficulties in finding the broken end.

Only then did Cao Mengda remember that Lu Cheng had performed a similar operation yesterday, so he moved his butt higher up the table and lowered his voice and asked: "Xiao Lu, this operation is in a hurry. Look at the sleeve I'm opening now. Can the position be nailed?"

Lu Cheng looked at the position of the sleeve outside the body, and then at the position of the sleeve inside the body, then pulled the sleeve out directly, then used a sharp knife to scratch and pull the original opening, and then installed the sleeve again. Got in.

Instantly, the field of view becomes much wider and the mobility is slightly stronger.

Seeing this scene, Liu Deqian's face was filled with surprise and joy. A good surgery must have a good field of vision. Lu Cheng's ability to do such a good field of vision will definitely save at least ten minutes of operation time!

It's just that this Lu Cheng is a graduate student called by Chen Bing. This TND is very embarrassing.

Why wasn't Lu Cheng discovered by him before?

Liu Deqian, whose mind was wandering, just accidentally saw Cao Mengda giving up the position of surgeon to Lu Cheng, and then saw that Lu Cheng, not knowing how, drove the outer row of nails into the humeral knot. The joint is on top, and after tightening, it starts to cross the line.

After crossing the line and reaching the operating position, Lu Cheng quickly picked up the rotator cuff suture device that he had never used before, and very accurately and skillfully threaded the suture out and returned it to the sleeve.

As a result, all that's left seems to be knotting.

Liu Deqian and Huang Biwei were stunned at that time.

Is this rotator cuff suture?
To be continued...