Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Effect of indomethacin on the pregnant rat

The objective of this study was to evaluate the reproductive performance, liver morphological study and post mortem characteristics of the pregnant Wistar rats treated with indomethacin, a general COX inhibitor. Indomethacin at doses of 0 (control), 0.32, 1.68 and 8.40 mg/kg/day were orally given once daily to each group (n=10) on days 3 and 4 of pregnancy (day 0 = first day of pregnancy = positive vaginal sperm). The animals were euthanized under anesthesia on day 11 of pregnancy, and were carried out necropsy and microorganism culture study. The results showed that the doses of 0.32 and 1.68 mg/kg body weight (the therapeutic dose for humans) of indomethacin caused no embryotoxic or lethal effects. The highest dose (8.40 mg/kg) of indomethacin disturbed implantation process and, thus, interrupted major development in some fetuses. The peritonitis was detected in the necropsy and in the bacteriological study of the animals treated with 8.4 mg/kg. It was considered death cause of these animals. Thus, this study analyzed a pharmacological agent on pregnancy in rodents and it provided some evidences that indomethacin presented embryotoxic and lethal effects at a high dose, but it was safe in the therapeutic dose used for humans.<br>O objetivo deste trabalho foi avaliar a performance reprodutiva, estudo morfológico do fígado e características " post mortem" de ratas Wistar prenhes tratadas com indometacina, um inibidor geral de COX. Indometacina foi administrada oralmente, nas doses de 0 (controle), 0,32, 1,68 e 8,40 mg/kg/dia (n=10/grupo), nos dias 3 e 4 de prenhez (dia 0 = primeiro dia de prenhez = esperma positivo). Os animais foram eutanasiados sob anestesia no 11º dia de prenhez, e foram realizadas necropsia e cultura de microorganismos. Os resultados mostraram que as doses de 0,32 e 1,68 mg/kg de peso corpóreo (dose terapêutica para humanos) de indometacina não causaram efeitos embriotóxicos ou letais. A maior dose (8,40 mg/kg) de indometacina prejudicou o processo de implantação e, portanto, interferiu no desenvolvimento fetal. A peritonite foi detectada na necropsia e nos estudos bacteriológicos dos animais tratados com 8,4 mg/kg e considerada a causa-morte destes animais. Portanto, este estudo analisou um agente farmacológico na prenhez de roedores e evidenciou que a indometacina apresentou efeitos embriotóxicos e letais na maior dose empregada, mas foi segura na dose terapêutica usada pelo homem