Chapter 872 The bloody level

En-Caule cesarean section is a newcomer in obstetrics.

Of course, only a few international hospitals are implementing it, and it is very difficult.

The so-called En-Caule cesarean section, also known as the cesarean section with the retention of the membrane sac, is as its name suggests, and the membrane sac will be retained during the cesarean section.

Traditional surgery will directly cut the lower uterine segment muscle layer, puncture the amniotic sac to absorb water and then deliver the fetus.

However, the cesarean section with the retention of the membrane sac is to deliver the membrane, amniotic fluid, and fetus together.

Most of the injuries of premature cesarean sections are caused by the incomplete formation of the lower uterine segment and the squeezing of the fetus by the uterine muscles.

However, if the membrane sac is retained intact, the amniotic fluid in the sac can provide hydraulic protection and resist external stimuli. The pressure on the fetus will be significantly alleviated, and all kinds of injuries can be minimized.

In addition, the cesarean section with the retention of the membrane sac will rupture the membrane immediately after the fetus is delivered, and the speed of sucking amniotic fluid is very fast. Basically, there will be no aspiration of amniotic fluid, and the probability of suffocation is very low.

However, the reason why this operation is not popular is that it is too difficult to operate.

The first difficulty lies in the fragility of the fetal membrane sac.

It is very thin, and it is necessary to press the fundus of the uterus when separating it.

It is almost as difficult as peeling a raw egg with bare hands without damaging the thin film on the surface of the egg.

Fortunately, the surgeon was Xu Qiu.

In less than ten minutes, the fetus wrapped in the fetal membrane sac came out. As the membrane sac was punctured and the amniotic fluid was sucked out, the fetus's cry resounded in the operating room.

Everyone present was so happy.

The fetus' life was saved!

The anesthesia team all looked relieved.

Finally, the fetus was delivered by cesarean section. Next, only Fang Jiajia, who was in charge of anesthesia, was needed to do it.

"It's a girl."

Although they knew the gender a long time ago, they were still surprised when the fetus appeared in front of everyone.

"Quick, evaluate!" Li Xue and Kong Huixia took a few glances, and ran to the neonatal intensive care unit with the fetus in their arms.

Before the operation, they promoted lung maturation. Nowadays, premature birth only meets the basic conditions for survival. Whether the baby can survive and live well is the work of the intensive care unit.

In addition...

The intelligence and cardiovascular development of the newborn also need to be checked.

...

In the operating room, with the departure of the cesarean section team, the operation has reached its climax.

The fetus was delivered in less than ten minutes, and the remaining parts of the cesarean section were completed in more than thirty minutes...

If it were a general joint operation, the cesarean section team could complete the operation in about half an hour and hand over the operating table. The cardiac surgery team would wake up with laughter in their dreams.

After all, the conventional time is about two hours.

With Kong Huixia as the main surgeon, it took two hours to complete the operation based on the complicated situation of the fetus in Fang Jiajia's abdomen.

However, even if it took only half an hour to complete, the main surgeon of the cardiac surgery department had no expression on his face.

After all, the main surgeon of the cesarean section and the main surgeon of the aortic dissection were both Xu Qiu...

This time, the modified SUN operation was still performed.

The anesthesia team immediately adjusted the plan.

Sedation and analgesia before anesthesia have been completed, and the main adjustments that need to be made are anesthesia induction and maintenance.

Due to the delivery of the fetus, Fang Jiajia's blood pressure dropped rapidly.

Fortunately, Xu Qiu had received vaccinations in advance, so the anesthesia team stabilized well.

Then, a combined anesthesia regimen of midazolam and fentanyl was used.

The drugs used to maintain anesthesia mainly include opioid analgesics and potent inhaled anesthetics.

After completing anesthesia induction, the cardiac surgery team put an ice cap on Fang Jiajia, and there was a temperature-controlled blanket underneath to cool the body surface.

Prepare an arterial single pump and double tubes...

Right axillary artery cannulation...

Right atrium bipolar cannulation for drainage, right upper pulmonary vein left heart drainage...

Soon, the nasopharyngeal temperature dropped to 20 degrees, and the anal temperature dropped to about 25 degrees.

At this time, the deformity surgical field was filled with carbon dioxide.

"Give methylprednisolone." The anesthesia director promptly carried out the next step of extracorporeal circulation.

The dose of this drug is about 15 mg per kilogram of body weight.

After adjusting the patient to a head-down position of 30 degrees.

Everything is ready.

At this point, the surgical requirements are finally met.

The first step is to establish extracorporeal circulation!

Clang.

Xu Qiu reached out and picked up a new scalpel and began to prepare for skin incision.

The modified SUN surgery is different from the conventional extracorporeal circulation surgery.

The surgery requires puncturing and measuring the pressure on the upper and lower limbs on the left side at the same time, and placing a central venous catheter in the right internal jugular vein.

However, the other steps are similar.

It is only necessary to leave a range of free cannulation for the axillary artery and femoral artery after laying the drape.

The next step is to free the right axillary artery.

Xu Qiu made an operation under the right clavicle, and made an incision perpendicular to the long axis of the body from the surface skin of the intersection of the middle and inner third of the clavicle to the outside. The incision is about six centimeters.

Then bluntly separate the pectoralis major muscle, and pull the deep pectoralis minor muscle outward with the thyroid pull groove.

After the tissue below was exposed, Xu Qiu first freed the axillary vein, quickly put on the band, and ligated the two branches on the upper edge of the axillary vein.

After completing these, the assistant pulls the axillary vein downward, and the axillary artery located at the upper back can be seen.

After freeing the axillary artery for two or three centimeters, the limbs of this segment are ligated, and the proximal and distal ends are bandaged separately for backup...

Then it is time for the thrilling thoracotomy stage.

Although it was a surgery, the sternum was still "split" when it was opened.

Although it required more precise operation than a butcher, at a glance, the sound of chopping bones was as if you were in a slaughterhouse with your eyes closed...

Apart from the bright and beautiful operating room, various high-end precision instruments, and neatly dressed surgical staff, the bloodiness of this scene was directly pulled to the maximum.

After gently splitting the sternum, Xu Qiu removed the remaining thymus, and then freed the innominate vein on the left, and found the innominate artery below after bandaging.

At the same time, the left common carotid artery, right subclavian artery, etc. were exposed.

As the blood vessels were marked, the key to establish extracorporeal circulation could also begin.

Under Xu Qiu's command, the cardiac surgery team acted quickly.

The double tubes of the arterial pump were connected to the patient's body in turn.

One was inserted through the axillary artery to establish extracorporeal circulation.

The other was inserted into the femoral artery for cannulation.

A second-stage ladder tube was inserted into the atrium.

"Cool down."

At one command.

The patient's body temperature slowly dropped, and soon, the various extracorporeal circulation pathways began to replace the heart's function.

Boom, boom, boom --

Boom, boom --