I, Aki Tomoya, will not be a simp.

Page 423

Yoshida Aoba breathed a sigh of relief and handed over the final task of closing the chest to Aki Tomoya.

Yoshida Aoba performed most of the surgery, handling the crucial parts. After suturing the open aorta, the heart successfully restarted without any other complications. The remaining task of closing the chest was left to them.

Without hesitation, Aki Tomoya switched places with Yoshida Aoba, allowing Majima to assist him in closing the patient's chest.

But halfway through the procedure, the patient's body began to move, and it seemed that the patient could open their eyes.

No one expected the situation to arise so suddenly.

Anesthesiologist Otani was stunned for a moment, while Majima and Yoshida Aoba both looked at Aki Tomoya, whose hand movements had paused.

Aki Tomoya paused for less than a second, glanced at the prescription casually, and quickly said, "5mg of diazepam and 0.1mg of fentanyl."

This is just a minor situation; it can be treated with tranquilizers, sedatives, and analgesics.

He wasn't supposed to remind the anesthesiologist.

However, perhaps because it was the first time performing such a surgery, Dr. Otani from the anesthesiology department made a mistake in his judgment.

During the surgery, Otani, who had been listening to Aki Tomoya administer anesthesia, had no doubts and quickly followed Aki Tomoya's instructions.

Aki Tomoya's movements were neither fast nor slow, highlighting his steady hands. It was just a task of closing the chest, and there was nothing challenging about it.

He had considered what would happen if he were the one to perform the emergency surgery, but unfortunately, Yoshida Aoba, for the sake of caution, did not entrust him with such an important task.

However, as the first assistant, I was more than capable in this emergency surgery.

The surgery lasted several hours, and by the time the patient became critical, it was already bright outside.

Several figures had appeared in the observation room above.

Aki Tomoya and the others did not notice this, as all their attention remained on the operating table.

After completing the chest-closing procedure and receiving instructions from Yoshida Aoba, everyone breathed a sigh of relief once he announced the end of the surgery.

Stepping out of the operating room, Yoshida Aoba looked at him for a moment, then asked, "Did you consider all the possibilities last night?"

Aki Tomo didn't think much of it and simply nodded.

After Majima went to the emergency room and underwent initial treatment and examinations, Aki Tomoya received the report from him and knew that surgery definitely needed to be performed as soon as possible.

If nothing unexpected had happened, the surgery should have been scheduled immediately after discussing it with Yoshida Aoba and the others in the department that morning.

However, an emergency operation was still performed here, using the existing team.

Thinking about how different the anesthesiologist who stayed on duty tonight was from Dr. Aoki, the doctor Yoshida Aoba used, the first thing Aki Tomoya thought of after the surgery was to make sure he could get along well with the excellent anesthesiologist.

The difference between an experienced anesthesiologist and an inexperienced one is truly enormous.

If Yoshida Aoba's personal anesthesiologist were to assist, there would be absolutely no need for him to intervene. He would know how to handle the situation based on his own observations, and there would be no need for him to worry about it.

However, during today's surgery, Aki Tomoya also gave many reminders regarding the anesthesia management.

This is also thanks to the fact that Aki Tomoya considered all aspects in the middle of the night.

As a chief surgeon, one must have the ability to control the entire situation in the operating room; this is something Yoshida Aoba always told him.

"Next time there's surgery, you be the lead surgeon, and I'll be your assistant, how about that?"

Yoshida Aoba looked at Aki Tomoya's expressionless face and said something that made Aki Tomoya very excited.

He thought he would have to wait at least another six months to become the chief surgeon, but judging from Yoshida Aoba's current demeanor, it was clear that she was ready to give him that opportunity.

"Really? Dr. Yoshida?!"

Aki Tomoya looked at him in surprise.

It was like a huge surprise had hit him on the head, leaving him somewhat incredulous.

Having only completed my medical training for a year, how come I was able to have the opportunity to be a lead surgeon or lead surgeon in a major hospital?

I am very satisfied with your performance tonight.

Yoshida Aoba patted Aki Tomoya on the shoulder, indicating that he didn't need to doubt.

From the moment the patient's condition appeared until they were taken to the operating room, Aki Tomoya's judgment was flawless, and he was able to perfectly cooperate with him during the surgery.

This is thanks to Aki Tomoya, who had been his assistant, accompanying him in and out of the operating room, while also striving to develop his skills as the chief surgeon and oversee the entire operation.

To be honest, he was quite nervous about the anesthesiologist he met today.

The anesthesiologists who assist them in cardiac surgery are fixed individuals. For example, he always has Dr. Aoki from the anesthesiology department assist him in every surgery.

As for Otani, if there were other people available and the situation were urgent, it would actually be best to have Aoki from the anesthesiology department come to the hospital.

But time was of the essence, and there was no time to lose. The patient's life was in danger at any moment, so there was no time to hesitate.

Even during the surgery, Aki Tomo doesn't spare half his energy for the anesthesia process; he constantly gives instructions.

However, Aki Tomoya's skillful handling, as if he had been prepared, allowed him to focus on the surgery and deal with the situations that arose in his field of vision.

Yoshida Aoba believed in one thing—

As the lead surgeon, I need to be able to control everything in the operating room.

Excluding such emergency surgeries requires flexibility, a normal surgery includes preoperative examinations, discussion of the surgical plan, consideration of specific intraoperative situations, complications, postoperative care, and flexibility during the surgery. As the core of a surgery, the surgeon bears a heavy responsibility.

"Aren't you touched to have me personally assist you?"

Yoshida Aoba felt that with him as his assistant, even if Aki Tomoya encountered problems during surgery, he could save the day. So he decided to give him a chance and train him properly.

"Please advise!"

Chapter 479 Watertight

"Dr. An Yi, what were your considerations when you became the first assistant anesthesiologist involved in the emergency surgery the night before last?"

The patient who underwent emergency surgery was transferred to the ICU for care after the surgery was completed on the morning of the day before yesterday. The surgery was successful, and the family expressed their gratitude.

However, after a short rest for a day, when he returned to the hospital, Sasaki Ichiru specifically called him in for a talk.

Sasaki deliberately used a slightly stern tone, especially emphasizing the word "intervention".

At the time, there were four people in the operating room, excluding the assisting nurses, including the anesthesiologist.

The chief surgeon was Aoba Yoshida, the first assistant was Tomoya Aki, the second assistant was Majima, and the anesthesiologist was Otani.

During the surgery, Aki Tomoya, who was the first assistant, repeatedly instructed the anesthesiologist Otani to administer anesthesia.

If the attending surgeon, Yoshida Aoba, were to speak, there probably wouldn't be too much trouble.

But now it seems a bit problematic that Aki Tomoya, as the first assistant, is speaking up?

Aki Tomoya was not yet aware of Sasaki Ichiru's purpose in coming to him to ask about this matter, but fortunately, he did not sense any malice from Sasaki Ichiru; it was just a business matter.

He wasn't sure if he had violated any taboos during the surgery, but the most important thing in the operating room was undoubtedly to save a critically ill patient.

After a moment's thought, Aki Tomoya slowly explained: "Whether a second mitral valve replacement surgery can be successful in the emergency of artificial mitral valve dysfunction depends on the perioperative anesthesia management."

"Having worked in cardiac surgery for almost three years, I understand this deeply, especially since this situation happened so suddenly. At the time, only Dr. Mashima and I were on the night shift in cardiac surgery, and the only one who could assist in the emergency surgery was Dr. Otani, who had little experience in heart surgery."

There was no complete surgical plan, only preparations made by Aki Tomoya and Mashima in the middle of the night, and the patient's condition was critical, requiring them to improvise.

Fortunately, Yoshida Aoba was staying in the hospital; otherwise, the surgical team would not have had a second assistant, and Aki Tomo would have directly taken on the role of chief surgeon, even if it meant gritting his teeth and doing it.

Similarly, in the anesthesiology department, there was only Dr. Otani.

At Kanto General Hospital, Aki Tomoya stayed for almost three years, and he remained in the Department of Cardiac Surgery the entire time, without rotating to other departments.

Therefore, in terms of experience, they are more experienced than new doctors who have just finished their medical training and transferred to cardiac surgery.

Having followed Yoshida Aoba around the operating room, Aki Tomoya understood even more clearly just how important an anesthesiologist is for surgery.

His statement about lacking experience in heart surgery is enough to show that Otani from the anesthesiology department was actually just going through the motions.

That person wasn't one of the anesthesiologists regularly used in cardiac surgery.

"The patient undergoing emergency cardiac surgery is critically ill. We are in a life-saving situation, which requires the anesthesiologist to establish rapid monitoring of arterial and venous pressure and to ensure smooth anesthesia induction..."

"We installed the cardiopulmonary bypass machine, pre-filled and degassed the tubing, and quickly established cardiopulmonary bypass while avoiding major interference with the patient's circulatory system. Our cardiac surgery team is usually well-trained and works closely together during the perioperative period, but this was an emergency at night, and I also had to assist Dr. Otani in establishing cardiopulmonary bypass..."

Under normal circumstances, every step of their cardiac surgery is meticulously planned, and the personnel are all experienced and well-trained.

Because of the shortage of manpower, Aki Tomoya and Mashima had to keep an eye on many things during the emergency surgery the day before yesterday, so as to avoid distracting the chief surgeon, Yoshida Aoba.

"Originally, like Dr. Aoki, anesthesiologists should be familiar with the pathophysiological changes of various cardiac diseases, as well as the pharmacological characteristics of various vasoactive drugs and anesthetics, so as to select appropriate vasoactive drugs and anesthetics according to the patient's condition..."

"This includes administering dopamine, dobutamine, and/or epinephrine, nitroglycerin, norepinephrine, morphine, etc., before anesthesia induction to maintain stable circulatory function as much as possible, creating conditions for anesthesia and establishing cardiopulmonary bypass, maintaining sufficient depth of anesthesia, and selecting drugs with minimal interference to the circulatory system as needed, with intermittent perfusion every 30 minutes..."

"It's obvious that Dr. Otani, who has never participated in heart surgery, lacks sufficient understanding of mitral valve replacement..."

So it's not that he's being nosy, but rather that he really needs to be reminded constantly.

Especially given the circumstances at the time, the patient's condition was critical, and no mistakes could be tolerated.

Interfering with the anesthesiologist's work was not Aki Tomoya's original intention, but rather because Dr. Otani indeed lacked experience and sufficient understanding of mitral valve replacement surgery.

Having the relevant experience and acquaintance, Aki Tomoya naturally offered his advice in order to ensure the smooth and successful execution of the surgery.

Considering the success rate of the surgery, Aki Tomoya felt that there was nothing wrong with doing so.

Even Sasaki Ichiru, after hearing Aki Tomoya's words, didn't think there was anything wrong with it.

As the head of cardiac surgery, Sasaki Ichiru is no stranger to the anesthesiologists, especially the few who regularly assist them in surgery; they have practically become their go-to anesthesiologists for cardiac surgery.

"Dr. Sasaki, I..."