On Monday afternoon, Dr. Liu went to the Thoracic Surgery Department for a routine preoperative visit.
As I walked, I looked at the surgical information brought by the thoracic surgery department: male, 79 years old, esophageal cancer...
He was thinking: Thoracic surgery doesn't really have to operate, right? Or is it a minimally invasive procedure with a small lesion? Logically, the risk of major surgery at this age is still very large. Regardless of him, as long as the surgeon dares to do it, there is no job that the anesthesiology department does not dare to take.
However, after seeing the medical records, he suddenly felt that it was not so simple: the patient's tumor, from the middle and lower part of the esophagus, extended to the cardia. This means that if you want to operate on it, you have to cut it all off.
If they are all cut off, what is the replacement for the esophagus?
Perennial surgical challenges are difficult, and Dr. Liu is very clear that he is replacing the stomach. Simply put, it is to lift the stomach upwards and connect with the esophagus.
However, in this way, you must open your chest!
Some people will ask, open the chest, open the chest, how can you still "open the chest"?
This is because, with the gradual popularization of thoracoscopy, most surgeries can be resolved in minimally invasive surgery under endoscopy.
Although he has not done anesthesia for open chest surgery for a long time, Dr. Liu is not afraid in his heart, but only slightly worried about the patient's postoperative recovery.
With mixed feelings, Dr. Liu went to the hospital bed to do some anesthesia-related physical examinations for the patient.
When he saw the patient himself, Dr. Liu was suddenly much more relaxed. Because, the elderly usually have the habit of exercising. Every morning, I have to go for a walk in the mountains. According to him, young people can't catch him.
Being able to wander around the mountains, you can almost tell that his cardiopulmonary reserves are very good. After inspection, it is really good. To this end, Dr. Liu's confidence has doubled.
In order to ensure that the operation of the elderly is foolproof, Dr. Liu carefully inquired about the history of various diseases of the elderly. Even the eating and sleeping habits of the elderly have been understood.
In the middle, the family also asked a question that almost made this operation "abort": Can this operation not be done?
Honestly, the current medical environment really makes patients ask this question. If you insist on doing it, it is difficult to solve the problem.
However, considering that the old man's condition has made his esophagus half obstructed. Without surgery, people will soon fail because of nutritional problems. As for how long they can live after cutting it off, no one dares to determine.
After some elaborate preparations, the surgery officially began.
During the operation, although the old man had a good physique, there were still some small conditions that occurred without danger. For example, when a surgeon focuses on the operation, the hand is accidentally pressed against the heart.
If you are young, you may only skip a few early beats. But in the old man's place, first premature beats, and then obviously irregular heart rhythm. If you don't shout stop, there may be a big problem.
In this way, after Dr. Liu called for a stop and a slow down several times, the operation finally completed the most critical anastomosis stage.
In this operation, the coordination of the chest opening stage is also quite critical. In the most critical "puffy lung" stage, Dr. Liu gently squeezed the ball with his hand. He knew that this step, if rushed, would most likely lead to a comenoplexedema in the lungs. If that's the case, the patient is at risk.
When the thoracic surgeon finished the last stitch, he looked down at the chest bottle next to the bed and asked Dr. Liu: How?
Rest assured, there is no leakage at all, and the color is not red.
A simple question and answer, everyone hears it is reassuring.
Next, everything will depend on Dr. Liu.
Worried about the slow awakening of the elderly, Dr. Liu has long made full preparations. In the past, opening the chest only required a general anesthesia; in this operation, due to the age of the patient, Dr. Liu added a paravertebral block to the addition of general anesthesia.
In this way, the problem of surgical pain is completely solved. During the operation, there was no pain signaling, and Dr. Liu controlled the anesthesia to a slightly deeper temperature than deep sedation, which also laid the foundation for early postoperative awakening.
After 10 minutes, the old man developed physical activity. Seeing the situation, Dr. Liu quickly called the old man's name, and the old man nodded slightly.
After successful extubation, the old man said "Did the operation do it?" "Let everyone feel a sense of accomplishment." Hours of fatigue, swept away.
In the afterglow, Dr. Liu also saw the surgeon's praise.
A lot of times, success is just a matter of trying harder. The success of this operation is inseparable from the mutual support of surgery and anesthesia, and even more inseparable from the 100% trust of patients and their families, and I wish the elderly a good rest of their lives!
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