Reducing the environmental impact of sterilization packaging for surgical instruments in the operating room: a comparative life cycle assessment of disposable versus reusable systems

The widespread use of single-use polypropylene packaging for sterilization of surgical instruments (blue wrap) results in enormous environmental pollution and plastic waste, estimated at 115 million kilograms on a yearly basis in the United States alone. Rigid sterilization containers (RSCs) are a well-known alternative in terms of quality and price. This paper deals with two research questions investigating the following aspects: (A) the environmental advantage of RCS for high volumes (5000 use cycles) in big hospitals, and (B) the environmental break-even point of use-cycles for small hospitals. An in-depth life cycle assessment was used to benchmark the two systems. As such a benchmark is influenced by the indicator system, three indicator systems were applied: (a) carbon footprint, (b) ReCiPe, and (c) eco-costs. The results are as follows: (1) the analyzed RSC has 85% less environmental impact in carbon footprint, 52% in ReCiPe, and 84.5% in eco-costs; and (2) an ecological advantage already occurs after 98, 228, and 67 out of 5000 use cycles, respectively. Given these two alternative packaging systems with comparable costs and quality, our results show that there are potentially large environmental gains to be made when RSC is preferred to blue wrap as a packaging system for sterile surgical instruments on a global scale.Gynecolog

Biventricular function in exercise during autonomic (thoracic epidural) block

Background Blockade of cardiac sympathetic fibers by thoracic epidural anesthesia (TEA) was previously shown to reduce right and left ventricular systolic function and effective pulmonary arterial elastance. At conditions of constant paced heart rate, cardiac output and systemic hemodynamics were unchanged. In this study, we further investigated the effect of cardiac sympathicolysis during physical stress and increased oxygen demand.Methods In a cross-over design, 12 patients scheduled to undergo thoracic surgery performed dynamic ergometric exercise tests with and without TEA. Hemodynamics were monitored and biventricular function was measured by transthoracic two-dimensional and M-mode echocardiography, pulsed wave Doppler and tissue Doppler imaging.Results TEA attenuated systolic RV function (TV SMODIFIER LETTER PRIME: - 21%, P < 0.001) and LV function (MV SMODIFIER LETTER PRIME: - 14%, P = 0.025), but biventricular diastolic function was not affected. HR (- 11%, P < 0.001), SVI (- 15%, P = 0.006), CI (- 21%, P < 0.001) and MAP (- 12%, P < 0.001) were decreased during TEA, but SVR was not affected. Exercise resulted in significant augmentation of systolic and diastolic biventricular function. During exercise HR, SVI, CI and MAP increased (respectively, + 86%, + 19%, + 124% and + 17%, all P < 0.001), whereas SVR decreased (- 49%, P < 0.001). No significant interactions between exercise and TEA were found, except for RPP (P = 0.024) and MV E DT (P = 0.035).Conclusion Cardiac sympathetic blockade by TEA reduced LV and RV systolic function but did not significantly blunt exercise-induced increases in LV and RV function. These data indicate that additional mechanisms besides those controlled by the cardiac sympathetic nervous system are involved in the regulation of cardiac function during dynamic exercise.Perioperative Medicine: Efficacy, Safety and Outcome (Anesthesiology/Intensive Care

SANG JENDERAL

xii; 183 hlm;13 x 19 c

Sang Jendral/ Friedericy

xii, 183 hal.: ill.; 19 c

Sang Jendral/ Friedericy

xii, 183 hal.: ill.; 19 c

Sang Jendral/ Friedericy

xii, 183 hal.: ill.; 19 c

Sang Jendral/ Friedericy

xii, 183 hal.: ill.; 19 c

Sang Jendral/ Friedericy

xii, 183 hal.: ill.; 19 c

A New Method to Improve the Environmental Sustainability of the Operating Room: Healthcare Sustainability Mode and Effect Analysis (HSMEA)

The purpose of this study was to describe a new method to effectively improve the environmental impact of operating rooms through a systematic approach. A proven successful prospective risk analysis tool to improve the safety of complex healthcare processes (Healthcare Failure Mode and Effect Analysis) was adapted to reduce the environmental impact of surgical waste. For this novel method, named the Healthcare Sustainability Mode and Effect Analysis (HSMEA), a multidisciplinary team, using a structured step-by-step approach, systematically inventories surgical waste, quantifies its environmental impacts, identifies hotspots, and provides solutions for improvement. The five steps of the HSMEA are described (definition of the topic, team assembly, flowchart creation, hazard analysis, actions and outcome measures) and the surgical procedure of a caesarean section was used as a case study to assess the applicability of this method to improve its environmental impact. Applying the HSMEA to caesarean sections resulted in a 22% volume reduction and a 22% carbon footprint reduction in surgical waste. This was achieved by revising the disposable custom pack in order to reduce the overage that was present, and by intensifying waste stream segregation for plastic and paper recycling. The HSMEA is a practical work floor tool to aid in the reduction of the environmental impact of surgical waste that is applicable to all types of operations. It is reproducible, and because it identifies carbon hotspots, it enables an efficient approach to the issue of operating room pollution

POCUS series: Focused transoesophageal echocardiography, a view from the inside

In the last decade, ultrasound has found its place in the intensive care unit (ICU). Initially, ultrasound was used primarily to increase the safety and efficacy of line insertion, but now many intensivists use point-of-care ultrasound (POCUS) to aid in diagnosis, assess therapy and support therapeutic interventions. In this series, we aim to highlight one specific POCUS technique at a time, which we believe will prove to be useful in your clinical practice. Focused cardiac ultrasound (FoCUS) is an important tool for the intensivist and can help in, among other things, diagnosing undifferentiated shock, evaluating the response to therapy and guiding procedures. FoCUS has, until recently, been performed with transthoracic echocardiography (TTE). FoCUS-TTE is, however, not always possible and not without problems. In this issue, we aim to describe the merits and pitfalls of focused transoesophageal echocardiography (FoCUS-TEE) in the ICU.Cardiolog