Chapter 148 Morality is not enough, but justice is enough! (Second update, please subscribe!)

Dissociative motor and sensory disorders are originally neurological diseases. In these disorders, there is loss of movement or impairment of motor function, either as loss of movement or loss of sensation!

But later in the anesthesia field, this feature can be used to judge whether an anesthesia machine is good or not.

It is also a reflection of the professional level of a top anesthesiologist.

If I only want to lose your motor function, then you just can't move, but you can feel pain, itching and touch!

If I only want you to lose your feeling, then I will just block your pain feeling.

If your surgical site is below the knee joint, then I will only remove the pain below the knee joint. If it is above the knee joint, I will lose.

There is quite a sense that the King of Hell wants you to die at the third watch and does not dare to leave anyone alive until the fifth watch.

What is the anesthesia status of this patient?

Well, he still has a certain degree of pain in his calf, and his toes can still move!

But the pain in my thigh has disappeared——

This specific principle is quite complicated, but as a top professor, Qin Dingmo still roughly knows the basic principles completed by Yang Yifeng.

As far as the innervation of the lower limbs is concerned, the lumbosacral nerves such as the left femoral nerve and femoral nerve have already determined the distribution areas of sensation and movement before they are synthesized——

L1: Inguinal area (including the uppermost part of the thigh).

L2: Front of upper thigh.

L3: The front of the lower thigh.

L4: Anteromedial surface of the calf.

L5: Medial half of foot.

S1: Lateral half of foot.

S2: Outside the back of the calf.

S3: Behind the thigh.

The above is positioning. Dominant positioning means only controlling the target area, which is determined by anatomy.

Then, when the nerve roots come out, they can be divided into front and back roots. The control functions of the front and back roots are different, generally speaking!

The front root is for movement and the back root is for feeling!

So, Yang Yifeng, the wolf killer, directly removed the posterior roots of L1/L2/L3, but left the other positions untouched.

Moreover, in order to consider that the sensory control of L1/L2/L3 is not enough to block all the sensations in the thighs, he also performed a precise cutaneous nerve block!

Is this something people do?

Although it is theoretically possible, that is just theory. Normally, the spinal anesthesia is done from the L4/L5 gap. At most, one side of the thigh is numbed, while the function of the other side is still retained.

He is already a very skilled anesthesiologist.

As for how to determine whether movement and feeling are separated, the best way to prove it is.

A good anesthesia can be hard, but a bad anesthesia can be soft! (If you have experienced spinal anesthesia, you must know the feeling. No more below~——~)

Such precise anesthesia?

Qin Dingmo looked complicated!

I'm so stupid, what an anesthesia machine?

To actually be prepared to perform an operation on such a villain - it's simply God's fault!

How great would it be if other critically ill patients could have such good nerve block anesthesia?

Some patients with various complications are unable to undergo surgery because they cannot undergo anesthesia.

As the director of the anesthesiology department, Zeng Yi naturally noticed Qin Dingmo's examination at this moment. His pupils shrank instantly and his eyes widened. He was still thinking back one by one. How did Yang Yifeng kill those sensory nerves?

, which ones haven’t been finished yet!

"Is it okay?" Cai Dongfan asked Qin Dingmo.

The corners of Qin Dingmo's mouth twitched, which was blocked by the mask, and he nodded: "Okay, Director Cai, you can perform the surgery."

Yang Yifeng then said, "Then I'll wash my hands first! Director Cai, I'm going to insert the venous filter. It won't affect your surgical field. We can do it at the same time."

"But please help me disinfect the right groin."

Cai Dongfan, Luo Yun and others had naturally washed their hands, put on clothes, etc., and made all preparations before the operation.

"Okay, go and wash your hands." Cai Dongfan nodded immediately.

Zhang Zhengquan and Du Yanjun are doing the disinfection work.

After Yang Yifeng left the operating room, Cai Dongfan personally worked with Luo Yunzhoucheng to determine whether the preoperative surgical instruments were complete!

…

Soon, Yang Yifeng walked in again. At this moment, Zhang Zhengquan and Du Yanjun had just finished the disinfection work and were spreading towels.

After Yang Yifeng took the initiative to put on his clothes, he took a deep breath and calmed down the fluctuations in his heart.

Secretly saying to myself, this man is the lunatic who ‘drunk and drives’——

I just want to send him to where he belongs.

After thinking this, Yang Yifeng suddenly broke through some obstacle and opened his eyes.

Then he continued to apply drapes, because he wanted to do a venous filter implantation from the femoral vein to the inferior vena cava, so Yang Yifeng chose the right femoral vein.

For venous filter implantation, the commonly used routes are through the right femoral vein, the left femoral vein, and the right jugular vein.

Among them, the right femoral vein is the preferred route. Because the right femoral vein is straighter than the left side and has less anatomical variation. Therefore, choosing the right femoral vein approach will reduce unnecessary trouble during the operation.

After Yang Yifeng simply spread the towel, he took out the graduated puncture needle in the puncture bag.

Immediately afterwards, the circulating nurse pushed over the color ultrasound.

Femoral vein puncture is generally performed using the relatively safe Sedinger puncture guided by color ultrasound!

However, before the circulating nurse could reach Yang Yifeng's side, Yang Yifeng's hand had already taken the puncture needle and inserted it directly.

Blind penetration!

Cai Dongfan, Luo Yun and others were completing preoperative preparations on their left lower limbs, so they didn't see it. However, Qin Dingmo and others who saw Yang Yifeng's movements were gripping the ground with their toes, holding their breath, and their hearts seemed to be racing.

Jumped to the throat!

——

Brother, what are you doing is femoral venipuncture?

Not the chest, nor the venules!

Next to it is the femoral artery and the femoral nerve!

Qin Dingmo didn't know how to describe Yang Yifeng's behavior at this moment.

However, Yang Yifeng didn't feel anything. He chose a suitable angle, pushed the puncture needle in, and inserted a 14F arterial sheath catheter.

Although the puncture is a vein, arteriovenous catheters are universal, and Yang Yifeng has long considered inserting the filter into the inferior vena cava, which is the common pathway for venous return of both lower limbs!

So I chose the filter model in the inferior vena cava, which is 14F!

After the catheter is inserted, it’s time to place the guidewire!

During the process of placing the guide wire, Yang Yifeng did not start blindly in a frightening manner. Instead, he pushed the color Doppler ultrasound machine to his side, and then used the probe to accurately detect the vein shape and guide wire head, and then began to gradually place the guide wire.

Along the direction of the vein returning to the heart, it first enters the iliac vein and then returns to the inferior vena cava.

After roughly seeing that the distal end of the guidewire passed through the renal vein, Yang Yifeng stopped entering.

After roughly determining the lumen of the vein under color ultrasound, a bird's nest filter was selected.

Under the guidance of the exchange guidewire, the inferior vena cava filter is inserted...

This process was quite smooth. After putting it in, Yang Yifeng monitored it again for a while. After seeing that the blood flow was still smooth, he took out the guide wire, then removed the arterial catheter sheath and bandaged it with pressure.

However, after the pressure bandage, for the sake of stability, Yang Yifeng kept the ultrasound head in the filter position, continued to monitor, and said to Qin Dingmo: "Professor Qin, I will observe the blood again now."

It's so fluid that it's out of shape. If you need to monitor the fat particles in your heart later, you can just take it away."

Although Yang Yifeng had completed the operation, he was still a little worried.

After all, when he operated on his mother before, her mother died on the operating table. Although the risk of that operation was exponentially higher than the current operation, it was still a vascular operation!

If it weren't for sending this big brother in, Yang Yifeng felt like he wouldn't be able to pick up the operating equipment this time.

However, Yang Yifeng felt an unspeakable secret hatred in his heart when he thought that the murderer who caused the death of his parents was out on medical parole and free from justice.

Qin Dingmo nodded and said: "It's okay, you should check yours first. In orthopedic surgery, only when the bone marrow cavity is washed, a large amount of fat will drip back into the blood system."

"The patient himself does not have three types of fat, so he can do without it for the time being."

As a top professor, Qin Dingmo is quite familiar with the conditions of each department.

Fat embolism, in addition to mostly occurring in patients with high blood pressure, is more common in joint replacement surgery.

That's because during the process of polishing the medullary cavity, fat particles will enter the medullary cavity, and at this time, the stability of the fat droplets will be affected and may deposit and form thrombus.

If the theory is clear, you will naturally not be afraid. This is how to handle it.

Not a little more useless effort and preparation, just perfect.

However, about five minutes after Yang Yifeng finished the operation and walked under the timing panel next to him, Cai Dongfan, Luo Yun and others happened to reopen the patient's previously debrided and sutured incision.

The operating room door was stepped open.

Then Zeng Yi turned around and saw Huang Shinan, the director of the Department of Hepatobiliary and Pancreatic Surgery, but under the brand name of Vascular Surgery, walking in.

After he came in, he saw that the operation of Cai Dongfan and others had just begun, so he smiled and asked: "Director Cai, it seems that I came at the right time. Your operation has just begun?"
To be continued...