Chapter 128 125. The operation ends

When a woman gets pregnant and gives birth, she is like taking a roller coaster. The previous ten months of pregnancy was a slow uphill accumulation of atmosphere, and when she was born, she was a downhill that released adrenaline from top to bottom. If the natural birth was still a progressive process to the gap, then cesarean section would pull this stimulation to the extreme and compress it into a short half hour to detonate.

Compared to natural delivery that takes more than ten hours, the speed of cesarean section is indeed very fast. From the incision of the skin to the child leaving the mother, it usually does not exceed 10 minutes, and it can come out in one or two minutes.

Originally, a relatively gentle change was suddenly accelerated, avoiding common problems such as perineal lateral incision and pelvic floor dysfunction [1], which will definitely bring other new problems.

Among them, the most important one is hemodynamics. [2]

The enlarged uterus suddenly shrinks and is pulled out of the abdominal cavity by Kaveti, which will cause the originally compressed inferior vena cava to rebound again, and blood from the lower body will begin to flow back into the heart in large quantities. In addition, the position of the operating table changes, this reflux should become more severe.

If it is modern, ensuring that the mother passes the surgery smoothly is something that the anesthesiologist needs to be responsible for.

But now, the only person on the stage who can judge Brenda's physical condition is Kawei himself.

Whether it is excessive blood loss or increased heart rate, it will cause a heart rate to rise [3]. However, if you only use the "heart rate increase" to reversely determine whether Bren has reached the bottom due to excessive blood loss or increased heart rate, then another variable needs to be added as a basis to judge.

Because the treatment of the two is completely different, if the heart blood volume is really increased by just a transient return, increasing the fluid immediately at this time will only further increase the heart load and make Brenda die on the operating table.

So even though the amount of bleeding has reached nearly 1,000ml, without the help of a blood pressure monitor, Kawei still sought stability for a while, watching them prepare to add medicine to the blood basin, and examined Brenda's body.

My breathing was fine, my pulse was a little weak, and my face turned pale.

Looking at the uterus that was still bleeding, Kawei made a decision: "Take a wide-mouthed bottle from my box, cover the gauze on the mouth of the bottle to make a funnel, and then pour the blood with the medicine into the bottle."

This is the anticoagulant that Kavey obtained after repeatedly going back and forth between the Medical School of the University of Vienna and the chemical plant - sodium citrate, also known as sodium citrate.

Compared with the common heparin in modern times, the preparation of sodium citrate is much simpler. The most important raw material is citric acid, that is, citric acid. [5]

Since it is a new drug different from oxytocin, it is necessary for Carve to explain: "In my second hometown, Italy, it is the best place for citric acid production in the world. Once my father made a mistake in his experiment, mixing citric acid and sodium hydroxide together, which gave us the honor of getting this new thing, sodium citrate.

It can effectively relieve blood clotting, using a dose of 2.5g per liter of blood, just like they are doing now.”

Since he used a basin to catch blood, many people in the audience found it strange. Now after listening to him describe the effect of sodium citrate, many people have realized what Carvey is going to do next: "You want to re-enter the blood that has left Brenda's body into her body?"

"Yes, I'm doing autologous re-energy." [6]

Another brand new concept, a brand new rescue idea, some people in the audience couldn't help but start discussing the feasibility of this approach. But for more other audiences, this step-by-step operation is crushing their common sense and ravaging their brains.

Once their thinking could not keep up, after seeing these dazzling things, they only left admiration.

As for cheering, let’s wait until Kawei completes the operation before taking it out.

The blood is filtered by eight layers of gauze and slowly flows into the wide-mouth bottle, and then poured into the infusion bottle and returned to Brenda's blood vessels through the rubber tube. The non-washed autologous reentertion has a very high collection rate. After 1L of blood is anticoagulated and filtration, it is enough to maintain Brenda's life.

"The bleeding has not stopped yet. When the basin is empty, I will take it over and continue to collect blood."

Kawei cleaned the uterine cavity again, Herman kept rubbing the uterine fundus with both hands, and Bergert helped hold the incisions on both sides of the uterus, and the bleeding in the implanted area continued: "The uterine cavity has been cleaned up, so I still choose the spiral sewing I had to do before, and suture the placenta stripping surface to achieve the purpose of stopping bleeding."

This stitching itself is also a product of experience.

Although suture can stop bleeding, it is also a traumatic intervention in itself, so the operation determines the quality of the suture: "Because the area where the placenta is implanted has become thinner, I chose to penetrate the uterus directly, increase the thickness of the suture to reduce the tearing of the suture on the peeling surface."

However, even if Kawei takes the operation to the extreme, it is still limited by the weakness in the material.

The sheep intestinal thread could not withstand this ligation force and it was broken three times in a row. It was not until the tougher silver thread was replaced with the wound.

But it was just a stitch and did not really stop bleeding.

Brenda's uterus was weak. After the uterus was incised, Salson injected six injections into the uterine muscles one after another, which was beyond the dose Nora had received. Now Carvey has encountered a second fork, whether to continue injecting oxytocin or choose to stop.

Continuing injection of oxytocin will greatly increase Brenda's blood pressure. It may not be visible now, but it is different when the blood is infusion. Various changes caused by various stress reactions in the body will gather in her body, creating a situation where it cannot be judged by guessing alone.

The lack of a blood pressure monitor is definitely the biggest challenge for Kavi.

Looking at the suture surface that kept bleeding, he didn't have much time to waste: "Continue to fight."

"good."

The unknown is fearless, Salson, who is taking oxytocin, Herman, who is doing uterine massage, Bergert, and Melen, who is undergoing blood filtration, all feel that the operation has come to this point in Kavey's calculations, and he does not know the risks behind every decision.

They were very excited because the operation had actually been successful at this point. The previously reported cesarean section of placenta previa ended with both mother and son.

As witnesses of the surgery, they feel sincerely proud.

The audience on the stage was even more excited because the operation was completely worth the fare. The new operating table, infusion, placenta implantation, rapid fetal removal, blood anticoagulation, autologous infusion, and every detail appeared for the first time in the Austrian surgical theater.

The most typical one is not someone else, but Varella, who knows that some surgical fur belongs to the audience.

He has always scoffed at the conservative Austrian surgery, and only praised Ignaz's surgical speed. He has always hoped that his country's surgical operations can be innovative so that he can stand in the ranks of a surgical power and make his work more stable.

Previously, Varella only regarded Kavi as a surgical star with surgical experience, full of luck, and bad operation.

He had expectations but didn't have much confidence, especially after Kawei chose to use a cleaner and time-consuming amputation, he felt that Kawei would ruin his work. Several negative reports from the daily newspaper were from him, with the purpose of suppressing Kawei and further maintaining the ornamentality of surgery.

However, today, Kavey's series of arrangements completely shattered Varrera's long-standing understanding of "ornamentality".

The Kavi, who was performing fine-tuned operations in the surgical incision, could become rough enough and not slow at all. At the same time, it also tells the world that the ornamentality of surgery is not limited to blood splashing and rapid operation, but also the innovations Varella hopes for.

Half an hour after the operation, the senior surgical journalist has mobilized all brain cells to understand and digest everything they see as much as possible. But even after spending 120% of the effort, he can only hear what Kawei said clearly, and it is still a long way from truly understanding.

In fact, let alone Varella, even surgical experts such as Ignaz, Watman, Olgi and Masimov who were sitting in the front row could only partially understand.

Many details that have been mentioned can only be skipped temporarily. After all, in a fast-paced cesarean section, keeping up with the rhythm is the most important thing.

"It's already the 10th oxytocin."

"Stop it first."

"Heart rate?"

“108.”

The large amount of oxytocin finally had some effect. The uterus had begun to shrink and the bleeding seemed to stop. However, Kawei's face was still cold. He looked at Begter beside him and said, "Relax the blocking belt in the lower part of the uterus."

"good."

The blocking belt separates a lot of blood flow from the uterus. If there is no active bleeding after being loosened, it can prove that the bleeding is successful. In fact, the peeling surface after suture is still bleeding. This feeling of powerlessness that can't change the situation without any means has left other people on the operating table with other ideas.

"If you can cut off the uterus."

"Well, there will be no bleeding if the uterus is cut off."

This is indeed a good way to go once and for all. It not only determines Brenda's life, but also allows the operation of Kave to be successfully completed. Such a dangerous placenta previa cesarean section can actually achieve the safety of mother and son, which is already an innovation that can show off all over the world.

However, Kawei's idea was completely different from theirs: "Don't think about these things that are not there."

"But the bleeding is too serious." As a second aid and a friend of his peers, Bergert still hopes that Kawei will stop the loss in time and retain this hard-won victory fruit. "If you continue to let it bleed, maybe"

"Well, stop for a while." Kawei buried himself in the wound and suddenly asked, "Who is the main surgeon?"

Bergert immediately realized the friend's attitude change, swallowed, and replied, "It's you."

"Who has the final say on the operating table?"

"Main Sword."

"So are you ordering the chief sword?"

"I'm just"

Bergert wanted to say something, but he felt that his calf was kicked and had to stop it.

The one who kicked him was Herman, who was standing aside and concentrating on uterine compression.

He knew very well that Kawei, like Ignaz, was a similar person who was the only one who could stand on the operating table and could not listen to advice at all. Not to mention him, Bergert, even Hills, who had been working in clinical practice for many years, wasn't Kawei kicked out of it?

"Sorry." Bergt immediately surrendered. Kawi's current abilities were definitely not something he could question casually.

Kawei gave him a blank look, used a lot of gauze on his hand to make intrauterine stuffing, and then slowly introduced the current situation: "I had ligated the upper upper artery on both sides of the uterus after blocking the lower part of the uterus. Now the hemostatic effect is not good, so I have to choose to continue ligating the lower artery on the uterus."

He has no room for hesitation, and continuing the surgery will increase the risk of infection. He must choose a more radical hemostatic strategy to end the surgery as soon as possible.

The lower uterine artery is in the lower uterus. If you want to do a sewing, you must perform anatomical separation of the lower uterus. The most important thing is to separate the bladder [7]: "Don't worry about blood supply, because the blood supply of the uterus is not only the arteries on both sides, but also other small blood vessels.

We push the bladder down to fully expose the artery descending branch of the lower part of the uterus. Note that we must use a scalpel to slowly cut and separate. Never use your fingers, because it will cause irreparable bladder damage. After suture and ligation, we need to check whether there is any accidental injury in the back and finally check the bleeding inside the uterus."

This is the last card that Kawei can take out. If this method cannot stop bleeding, Kawei will have to undergo a hysterectomy.

Fortunately, the ligation effect of the upper and lower parts is good, and the wound that has just been sutured in the uterus finally stopped bleeding.

"Heart rate?"

“101.”

"breathe?"

"It's still the same as before."

Kavey looked at Brenda with a pretty good face and finally breathed a sigh of relief, bringing the audience the final result: "Because the bilateral uterine artery was completely ligated, the bleeding has stopped now. The child survived, and Ms. Brenda survived, and I announced that the cesarean section was successful."

This "success" is just the result of compromise under the existing surgical cognition, and the real test is still postoperative care.

But for the audience, this success is enough to rewrite the end of the obstetrics. Both operations ended successfully. Kawei took the cesarean section on the operating table alone, telling the world that when a difficult delivery, the mother does not need to die, and they have other options.

Many people in the venue even ignored the operation being over and started cheering Kawei's name.

But the young surgeon didn't care about this, and cheering would not completely recover Brenda, and he would have to assign nursing tasks to the next step.

"Bergate, put the remaining oxytocin into saline and continue to be injected slowly with the infusion bottle." Kavey handed the suture needle to Herman, "If you sew the skin, you must sew tighter and don't break the thread."

"Yeah, I know."

"Salson, go find a sandbag. Her uterus contracted too poorly. There is no good way to continue relying on oxytocin. It must be treated with pressure."

"good."

"The two midwives went back to tell the nurse that they would do abdominal compression every once in a while and they would be sure to discharge all the blood clots."

"good."

"Melen, I'll leave the remaining blood to you. After filtering, continue to enter it into her body as you did just now."

"Um."

Kavey bowed to the audience behind him: "The operation is over."
Chapter completed!