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If you just look at the procedure, epidural anesthesia does not seem to be complicated.

First, use a syringe to infiltrate the puncture point on the patient's back for infiltration anesthesia, and then insert the puncture needle into the spinal canal epidural, and then you can inject lidocaine to act on the nerves in the spine, selectively causing the patient to lose part of the body pain.

Of course, it just doesn't seem complicated.

In fact, as one of the most risky specialties in clinical practice, the work of anesthesiologists is of course not so simple, they need to summarize the examinations done by surgeons to patients before surgery, consider the way to choose anesthesia, the dosage of anesthetics and various risk factors, etc., so many patients' family members stuff red envelopes before surgery, in addition to the surgeon in charge of the operation, they also give one to the anesthesiologist, which is the reason.

It's like an epidural, it's hard to do without rigorous training.

John is a pure novice, although he has a complete operation process in his mind, but after all, he is not a professional anesthesiologist, so he can only grope for it step by step. After repeating it on the animals many times, John dared to try it on Robert and them, and finally used it for surgery.

A qiē operation must be carried out carefully.

After the detoxification and local infiltration anesthesia, Mr. Miller felt like he had been pricked by a needle, and then he no longer felt pain. Miller could feel John's hands very clearly, he knew that the young surgeon was doing something on his back at this time, but gradually it was like the lower half of his body was no longer his own, and he had no feeling at all!

It's a really amazing feeling.

Also wonderfully are Dale, Hines and Wolfgang. They watched John's movements with wide eyes: after using the syringe for local infiltration anesthesia, and after confirming that Mr. Miller was painless, they took out a long, thin puncture needle!

Looking at theory and practice, the feeling is completely different.

"Gentlemen, the deep infiltration anesthesia before the puncture must be perfected!"

While everyone was staring blankly, John patiently explained with a puncture needle: "Because the local anesthesia patient is conscious." If the infiltration anesthesia is not perfect, he will feel pain when he waits for the next puncture, causing reflex tension in the back muscles...... Mr. Miller, how do you feel? ”

"It's fine."

Mr. Miller, who was still very nervous, nodded slightly and replied in a muffled voice.

"Good, I need you to stay motionless next!"

Solemnly instructed Mr. Miller, John took a deep breath, first stabilized his hands, and then inserted the long puncture needle along the gap between chest 10 and chest 11 according to the operation technique of a deputy chief physician of the anesthesiology department in his memory!

"Sizzle......"

Toothache like. Dale and Wolfgang gasped at the same time.

Although one is a surgeon, it is common to use a knife or even a saw on a patient on weekdays, and the other is a professor of internal medicine, and he has already read John's relevant papers, but at this time, seeing John poke such a long puncture needle into the patient's back, the two of them are still inexplicably cold in their hearts!

That's the spine!

However, at this time, John didn't care about their feelings, and carefully operated with bated breath until the puncture needle in his hand felt a slight sense of resistance to break through. Finally, he breathed a sigh of relief and shouted in a low voice: "Wipe my sweat!" ”

Paul immediately stepped forward. He took a piece of gauze and wiped John's sweat.

Without air conditioning, it is impossible to open the windows for ventilation, and even if John has made all kinds of preparations, the temperature in the operating room has reached nearly 30 degrees Celsius! John is really thankful that he didn't have so many books to read in his life, otherwise it would have been miserable to have an eye for surgery......

"Mr. Huntelaar, how do you tell if the needle is epidural?"

Seeing John pause for a moment. Dale immediately asked impatiently.

"By feeling."

After hesitating slightly, John nodded and said, "If you have carefully read the vertebral anatomy diagram I drawn, the vertebral arch plates of the adjacent two vertebrae are composed of three ligaments, and the innermost is the ligamentum flavum, which is very tough and thick. If you encounter it when you are pierced, you will feel resistance...... So if I feel that the resistance is gone, I will initially tell that the tip has reached the epidural! ”

Sounds simple, doesn't it?

Historically, however, there has been no such "obvious" experience in the decades since the advent of neuraxial anesthesia, and it would have taken surgeons at least thirty years to come up with this simple experience! In the absence of ventilators, intravenous access, and various rescue drugs, countless patients died tragically under the puncture needles of doctors, accumulating painful experience for other patients......

"In addition to this feeling, we can also confirm the ...... with the phenomenon of negative pressure."

With a blink of an eye, John simply spoke of another phenomenon that would not be discovered until more than forty years later. Anyway, for him, the excellent results in physics are also well known, and it should not be a big deal to say this little "little experience".

Sure enough, after listening to John's words, the crowd was not too surprised.

Now that even the techniques of lumbar puncture and neuraxial anesthesia have been published, some simple tips are naturally nothing, and at this moment, everyone is more concerned about the process of injecting anesthetics and the effect of anesthesia!

"Gentlemen, before you can give a sufficient dose, you must first inject a real dose!"

Before injecting Miller with lidocaine, John continued with a solemn face: "After our practice, we found that although the local anesthetic is relatively safe, it still has a certain toxicity after all, so it should be injected in a small dose for the test first, if there is lower limb pain, loss of movement and blood pressure drop within five minutes...... Gentlemen, the consequences can be very severe! Of course, since I will give you the anesthesia myself, you don't have to worry, Mr. Miller! ”

As he spoke, John felt that something was not right, and hurriedly comforted Mr. Miller, who was trembling slightly.

"Damn it!"

After Mr. Miller is calmed down. John scolded himself secretly.

If it is general anesthesia, he can naturally explain to others the various precautions during the period and the dangers that may exist, but now the local anesthesia technique is used, and the patient is even sober, isn't it asking for trouble for himself to say so much? After discovering this, John's next operation was firmly shut. Five minutes after injecting the dose, one qiē is normal. John gave Miller a booster dose, completing the epidural this time.

Mr. Miller after the anesthesia aroused the interest of the others, and when John briefly tested the effect of the anesthesia, Hines immediately stepped forward and asked, "Mr. Huntelaar, can I check the effect?" ”

"No, no! Mr. Hines, please return immediately! ”

John was slightly startled, and immediately shouted extremely harshly.

"Huh?"

Startled, Hines immediately took a step back and returned to his original position.

Not waiting for the stunned Hines to post. John, who was a little annoyed, already frowned, and said urgently: "Mr. Hines, have you forgotten what I said before I entered the operating room?" Thomas and I are the only ones who can touch the patient during the procedure, and if you can't follow this rule strictly, I'm afraid I'll have to ask you out! ”

John's words, unceremoniously!

Hines was stunned, the expression on his face was obviously not very good, but he turned to look at Professor Bergman, who was expressionless. He could only nod his head and said, "Sorry sir, I'll pay attention." ”

Hines was upset. The sudden episode also made John a little unhappy, and his face instantly became gloomy. The editor of German Medicine really annoyed him, and other big names such as Bergman and Wolfgang did what he told him to do, but one editor actually committed a foul, which made John regret his decision to agree to Professor Bergmann.

Also regretting was Professor Bergman, who glared at Hines and whispered, "Mr. Hines." Please don't give us trouble! ”

"Yes, Professor Bergman."

After listening to Bergman's words, Hines was thoroughly honest.

This was not the time to get angry, and John asked Mr. Miller to lie down and said in a deep voice, "Thomas, let's get ready to disinfect the cloth!" ”

Thomas and Paul immediately got busy.

While the two of them are operating. John hesitated for a moment and then turned around and began to explain: "Gentlemen, everyone should know my theory of resident bacteria, so it is not enough to simply disinfect the area around the incision with alcohol, I use iodine tincture that has just been invented. However, due to the irritating effect of iodine tincture, deiodization must be carried out with alcohol. In addition, in order to protect the surgical incision from infection, we also need to put a towel on the patient...... I have already written out the specific methods and precautions, if you are interested, you can wait for the end of the operation to see! ”

When John said this, he paused slightly, looked at Hines not far away, and continued: "But here I want to emphasize again, gentlemen, when you observe the operation, you must keep a distance from the operating table and us, and you can only look at it or never touch it!" ”

After hearing John's words, Hines's face suddenly burned.

But before the angry Hines could say anything, Professor Bergman next to him had already nodded: "Don't worry, John, you go ahead with your surgery, and I'll take care of the rest of the rest!" ”

Professor Bergman's existence was enough to suppress all of Hines's grievances.

John, who had settled down, refocused on the patient, but after a moment's hesitation, he still explained in a deep voice: "Gentlemen, the purpose of sterilization and towel laying is to protect the surgical incision from infection as much as possible, and for an abdominal surgery, in addition to determining the cause and surgical site, it is obviously very important to choose the right surgical incision. It also summed up some of the key points to pay attention to in the operation......" (The novel "Doctor 1879" will have more fresh content on the official WeChat platform, and there will be a 100% lottery gift for everyone!) Open WeChat now, click on the "+" sign in the upper right corner to "add friends", search for the official account "qdread" and follow, hurry up! (To be continued......)