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

Abstract 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

Ethylene glycol for freezing ram semen in pellets

Com a finalidade de avaliar a eficácia do etileno glicol para a preservação do sêmen ovino, utilizou-se 16 pools de sêmen, sendo cada um dividido em quatro alíquotas com concentrações de 0,3M, 0,5M e 0,7M de etileno glicol par a comparação com 0,72M de glicerol. A avaliação do sêmen por teste de termo-resistência demonstrou que a motilidade inicial, final e vigor final foram semelhantes para 0,5M de etileno glicol e 0,72M de glicerol, e superiores aos demais tratamentos. No entanto, o grupo que utilizou o etileno glicol em 0,5M proporcionou uma melhor proteção acrossomática. Setenta ovelhas divididas em três grupos (etileno glicol 0,5M, glicerol 0,7 2M e sêmen fresco), foram submetidas a sincronização de cios, inseminação, pela via cervical e diagnóstico de gestação aos 45 dias de gestação por ultra-sonografia. Não foram observadas diferenças significativas entre o grupo do etileno glicol com os do sêmen fresco e glicerol, porém verificou-se diferença entre os grupos do sêmen fresco e do glicerol. Considerando os resultados obtidos, conclui-se que o etileno glicol utilizado na concentração de 0,5M propicia motilidade e vigor semelhantes ao glicerol (0,72M), porém proporciona uma melhor proteção acrossomática. _______________________________________________________________________________ ABSTRACTThe aim of the present study was to verify the efficiency of ethylene glycol for freezing ram semen. A total of 16 pools of semen was used and each pool was divided in four fractions, which were frozen with ethylene glycol (in concentration of 0.3M, 0.5M or 0.7M) or glycerol (0.72M; control group). The percentage of motile spermatozoa after thawing (initial motility) and after 5 hour of incubation at 37°C (final motility) as well as the final sperm vigor were similar after freezing with ethylene glycol (0.5M) and glycerol (0.7 2M). The other concentrations of ethylene glycol resulted in lower sperm motility and vigor. However, ethylene glycol, in the concentration of 0.5M, was able to increase the number of sperm with intact acrosomes. Seventy ewes were divided into three different treatments (ethylene glycol-0.5M, glycerol-0.72M and fresh semen). The estrous were synchronized and the ewes were inseminated by cervical technique. Forty-five days after finishing the artificial insemination program, pregnancy diagnosis was performed by ultrasound. The pregnancy rate was similar when the ethylene glycol treatment group was compared to the glycerol and fresh semen. However, the percentage of pregnancy was higher in the group of ewes inseminated with fresh semen than with semen frozen with glycerol (p<0.0003). Considering these results, we can conclude that ethylene glycol in a concentration of 0.5M is efficient for freezing ram semen, allowing post-thaw sperm motility similar to glycerol (0.72M) but with higher number of intact acrosomes

Criopreservação do sêmen ovino em Pellets com etileno glicol Ethylene glycol for freezing ram semen in Pellets

Com a finalidade de avaliar a eficácia do etileno glicol para a preservação do sêmen ovino, utilizou-se 16 pools de sêmen, sendo cada um dividido em quatro alíquotas com concentrações de 0,3M, 0,5M e 0,7M de etileno glicol par a comparação com 0,72M de glicerol. A avaliação do sêmen por teste de termo-resistência demonstrou que a motilidade inicial, final e vigor final foram semelhantes para 0,5M de etileno glicol e 0,72M de glicerol, e superiores aos demais tratamentos. No entanto, o grupo que utilizou o etileno glicol em 0,5M proporcionou uma melhor proteção acrossomática. Setenta ovelhas divididas em três grupos (etileno glicol 0,5M, glicerol 0,7 2M e sêmen fresco), foram submetidas a sincronização de cios, inseminação, pela via cervical e diagnóstico de gestação aos 45 dias de gestação por ultra-sonografia. Não foram observadas diferenças significativas entre o grupo do etileno glicol com os do sêmen fresco e glicerol, porém verificou-se diferença entre os grupos do sêmen fresco e do glicerol. Considerando os resultados obtidos, conclui-se que o etileno glicol utilizado na concentração de 0,5M propicia motilidade e vigor semelhantes ao glicerol (0,72M), porém proporciona uma melhor proteção acrossomática.The aim of the present study was to verify the efficiency of ethylene glycol for freezing ram semen. A total of 16 pools of semen was used and each pool was divided in four fractions, which were frozen with ethylene glycol (in concentration of 0.3M, 0.5M or 0.7M) or glycerol (0.72M; control group). The percentage of motile spermatozoa after thawing (initial motility) and after 5 hour of incubation at 37&deg;C (final motility) as well as the final sperm vigor were similar after freezing with ethylene glycol (0.5M) and glycerol (0.7 2M). The other concentrations of ethylene glycol resulted in lower sperm motility and vigor. However, ethylene glycol, in the concentration of 0.5M, was able to increase the number of sperm with intact acrosomes. Seventy ewes were divided into three different treatments (ethylene glycol-0.5M, glycerol-0.72M and fresh semen). The estrous were synchronized and the ewes were inseminated by cervical technique. Forty-five days after finishing the artificial insemination program, pregnancy diagnosis was performed by ultrasound. The pregnancy rate was similar when the ethylene glycol treatment group was compared to the glycerol and fresh semen. However, the percentage of pregnancy was higher in the group of ewes inseminated with fresh semen than with semen frozen with glycerol (p<0.0003). Considering these results, we can conclude that ethylene glycol in a concentration of 0.5M is efficient for freezing ram semen, allowing post-thaw sperm motility similar to glycerol (0.72M) but with higher number of intact acrosomes