Surgery Godfather-Chapter 390 - 0368 Tracheal Intubation

Chapter 390: Chapter 0368: Tracheal Intubation Chapter 390 -0368: Tracheal Intubation During the competition, Director Gao still often visited the Department of Orthopedics; besides watching surgeries and auditing the case discussions, he also kindly asked how he could offer help.

His care was not just verbal, but was demonstrated in action: Old Gao drafted several young and capable doctors to support the Orthopedics Department, assisting them in various tasks such as writing case studies.

Upon knowing that arthroscopic surgery was the centerpiece of the national competition’s first season, Old Gao had already mobilized out-patient doctors within the department in advance to channel suitable cases to Orthopedics.

This way, during the competition, Orthopedics Department would have a wealth of cases to choose from.

Once Lu Gang’s surgical plan was confirmed, Yang Ping began to finalize the details.

A lack of attention to detail could ruin everything: surgery, after all, focused heavily on the details.

A single oversight could demolish all the hard work put into the surgery.

Yang Ping was a rational person; he was ardent, yet did not rely on passion to achieve his goals. Instead, he utilized scientific methods.

He solved all matters, piece by piece, based on Lu Gang’s actual medical condition to ensure the surgery’s biggest possible success while also making it as safe as possible.

Despite having advanced medical equipment, Yang Ping would not dare take a single procedure lightly or let loose for even a second.

He continued to maintain an attitude of walking on thin ice and was always walking on the edge of a cliff.

Lu Gang’s surgery required general anesthesia, which meant intubation was necessary.

Consequently, the first hurdle was the difficulty of intubation.

The first intubation during surgery had to be performed while Lu Gang remained conscious.

Lu Gang’s severe cervical kyphosis and rotational deformity made inserting a tube into his airway extremely difficult.

Despite the fact that a bronchoscope could be used for guidance, there was still the possibility of failing to insert the tube.

If they failed to intubate, anesthesia could not be performed. Without anesthesia, ensuring the continuation of the subsequent surgeries would be impossible.

Therefore, not only did Yang Ping need to address the surgical issues, but he also needed to assist Liang Fatty in overcoming the anesthesia-related issues.

If necessary, he would personally take over and perform the tracheal intubation.

Even if the tube could only be maintained for just a few minutes, as long as it was inserted, the resulting pressure on the back of the throat and tracheal walls wouldn’t matter.

As swiftly as possible, he would complete the double knee and hip joint osteotomy to increase the distance between Lu Gang’s head and trunk.

Only then would Lu Gang be able to proceed with the second step: cervical spine correction.

After accomplishing normal curvature through cervical spine correction and lifting Lu Gang’s head, he might be able to achieve a suitable prone position.

The third step was to perform thoracic and lumbar spine corrections in the prone position.

The last step, the fourth, was to perform hip and knee joint arthroplasty on both sides.

Lu Gang’s hips and knee joints had contracted to the point of being dorsoflexed for a long time, leading to the formation of a double joint stiffness: contracted extrajoint soft tissues and bone fusion within the joint.

Only through joint arthroplasty could he regain normal hip and knee joints and restore his ability to walk normally.

Yang Ping painstakingly considered and refined every detail, striving for perfection in every way.

Liang Fatty did not idle either. After work, he stayed in the laboratory studying Lu Gang’s tracheal intubation.

The rabbits were unlucky: Fatty immobilized them in a twisted posture, employing a newborn’s tracheal intubation kit. He practiced extensively on them.

If any animal rights activists were to witness this scene, they would certainly spit blood from anger and desire to beat Fatty up.

“I’m sorry, Brother Rabbit. I, Liang Fatty, have no choice but to do this for the sake of saving people. After the surgeries, I will definitely treat you well and no longer make you suffer,” Fatty murmured in guilt to himself.

After failing several times to insert the tube and causing distress to the rabbits, Fatty, a little disheartened, sneaked off to the bathroom for a smoke of Soft Zhonghua before continuing his practice.

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Working with live rabbits as practice models was more realistic. When Fatty inserted the bronchoscope, the rabbits were able to tolerate it. But once the laryngoscope went in, they would immediately bite down on it due to the stimulation and struggle fiercely.

Fatty kept reminding himself- if Yang Ping’s Everest-level surgeries were to fail because of missteps in the intubation process, Liang Fatty’s reputation would be ruined. And Liang Fatty already had quite a good reputation in the hospital; several head nurses were trying to introduce him to their girlfriends.

Upon observing his numerous failures, Yang Ping stepped in to assist him, demonstrating and teaching him along the way: “You need to have a mental image of the path from the mouth to the laryngopharynx, and then from the laryngopharynx to the trachea. Your hands should also have a sense of the anatomy. Look, you have tied up the rabbit in such a twisted posture that its airway is no longer in its normal state. Even inserting a bronchoscope would be difficult, let alone a tube.”

Fujiwara Miyuki, who was practicing arthroscopy in the lab, paused her training and attentively listened to Yang Ping’s explanation.

Yang Ping tried many times in the system space and was now teaching Fatty how to accomplish intubation under these extreme conditions.

“Open the mouth a little to expose the epiglottis. Do you see those two openings? Remember them, don’t mistake them. The front one leads to the airway, and the back one leads to the esophagus. The airway is curved, but there is still a slit, otherwise how does it breathe?”

“Do you see the slit of the glottis?” Yang Ping showed Fatty while Miyuki leaned in closer to observe.

The bronchoscope navigated the intricate and winding passages like a snake exploring its path.

On the screen, like a first-person perspective in a counter-terrorism game, it advances, pauses, advances again, pauses again, going deeper all the way.

Guided by the fiberoptic bronchoscope, Yang Ping deftly and quickly inserts a laryngoscope with his left hand, following the curve of the tongue, gently lifting up the epiglottis at the base of the tongue. The vocal cords are revealed on the electronic screen.

“When it inhales, you go deeper. Seize the moment of inhalation and make your detailed movements smooth and natural.”

The rabbit inhales, the glottis opens, and Yang Ping’s endotracheal tube in his right hand quickly enters the trachea, passing the vocal cords by 4 cm. Looking at the scale on the tube, it’s about 18 cm from the incisors. Very Good.

Yang Ping pulls out the stylet, places a dental pad, and withdraws the laryngoscope and bronchoscope.

“Stethoscope!”

Yang Ping listens to the lung sounds on both sides with a stethoscope, confirms the intubation is correct, secures the tube and dental pad, and injects 5ml of air into the balloon on the tube, sealing the gap between the tube and the tracheal wall.

The tracheal intubation is successfully completed. Yang Ping removes his gloves: “The difficulty lies in the fact that the oral cavity, pharynx, and trachea are not in a straight line, forming some bends. Some sections are flattened. Each bend must be carefully negotiated, and each flattened section must be carefully dilated.”

“Be gentle, try not to damage the inner wall. Even with topical anesthesia, try to reduce the stimulation because the topography inside the airway is complicated. Some areas are hard for the anesthetic to reach, and due to insufficient anesthesia, there will still be stimulation.”

“The deeper you go, the more sensitive it becomes. The pharynx can trigger a gag reflex, and the tracheal mucosa can trigger a cough reflex. These reflexes cause restlessness and spasms, making it impossible for you to go any deeper. Adequate skill and flexibility are prerequisites for you to go deeper.”

“The instrument in your hand must be spirited, adjusted according to the airway, not rigidly thrust in.”

Yang Ping explains the key points clearly to Fatty, who takes them to heart.

In their spare time from performing surgeries, Zhang Lin and Little Five are studying Lu Gang’s postures, how to sit during several surgeries, how to position themselves, and how to expose the hooks properly.

In this team, even correctly attaching the hooks is not an easy task.

The 3D printed models, over a dozen of various sizes, include full-scale models of the human body, smaller models, models of the spine, and models of the cervical spine and the base of the skull.

Zhang Lin and Little Five are currently using Lu Gang’s full-scale model to demonstrate how to position.

Several surgeries, each with a different position, Zhang Lin and Little Five need to study repeatedly.

Fatty has practiced intubating for a long time and is a bit tired. He wants to rest a bit and then follows Zhang Lin and Little Five to study positioning.

Fujiwara Miyuki puts on rubber gloves, takes Fatty’s instruments, and tries to practice this extreme state of intubation.

After several unsuccessful attempts, she asks Yang Ping for help. Yang Ping has no choice but to turn around and teach her, taking over her bronchoscope.

Fujiwara opens the rabbit’s mouth, and Yang Ping, watching the screen of the fiberoptic bronchoscope, guides her, “Try to pry upwards as much as possible, open up a little, otherwise you can’t get it in.”

Without damaging the teeth, you need to open the mouth as much as possible to expose the throat so you can intubate. This special position requires a high level of exposure skill.

“Don’t be afraid, open up a little more, yes, you’re about to go in, don’t move around, excellent, you’re in.”

Under Yang Ping’s guidance, Miyuki tried a few times and finally succeeded.

“Now that you’re in, don’t move around, feel it for yourself.” Yang Ping encourages her to properly experience the sensation of guiding the tube over the vocal cords and into the trachea.

“It hurts a bit!” Miyuki switches hands to support the tube, flexes her wrist, and begins to secure the tube.

Several of the movements in the previous tracheal intubation were quite awkward, requiring a large range of wrist motion, reaching the limit. After trying a few times, her wrist naturally feels sore and painful.

“You’re too tense, relax!” Yang Ping comforts her.

Zhang Lin, Little Five, and Fatty figure out the optimal position, and ask Yang Ping to look over and see if it’s suitable.

After work, no one has time to rest. Song Zimo is preparing for the first season’s surgery. Xu Zhiliang is planning for the following season’s surgery.

In particular, for the robot-assisted surgeries, he needs to arrange a certain number for Yang Ping to do as warm-up training. Takahashi has to help them both.

But Yang Ping forbids them from staying up late, prioritizing health over hastening the surgeries.

Sacrificing health for work is one thing when there’s no choice, but when there’s room to adjust, it’s better to protect your health and thus work more efficiently.

Everyone must stop working before ten o’clock, as per Yang Ping’s orders.

Yang Ping’s own schedule is also packed. Every Saturday, he also has to perform surgeries with Boss Cheng.

Yingge Hospital in Malaysia also wants Yang Ping to perform surgeries there. Yang Ping responds that he’ll only have time after the Golden Knife Award.

Although learning and training can be done in the system space, things in reality also need to be done one at a time. Therefore, time management is extremely important.

Song Zimo and Lin Hao’s face-off is quickly approaching. Each of them is fully prepared.

In the first season, they have to go through six major joint arthroscopies of the entire body. Then they have to perform a foraminotomy, followed by multi-ligament reconstruction of the shoulder and knee joints.

Doctors who love arthroscopy can hardly contain their excitement. Old Gao is like this, exceptionally excited.