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

Safety and consumption of sevoflurane versus desflurane using target controlled anesthesia in children

Background: Recently a concept of target controlled inhalational anesthesia (TCA) is introduced in which the fresh gas flow and its composition are automatically delivered to the patients with the least possible flow. The aim of this study is to compare safety, consumption and cost of both sevoflurane and desflurane when delivered by target controlled anesthesia (TCA) using fully closed circuit conditions. Patient and method: After approval of the hospital review board and obtaining parental informed consent, 60 pediatric patients aged 2–12 were selected. The patients were classified into two groups according to the anesthetic used S Group (n = 30) in which sevoflurane D Group (n = 30): in which desflurane was used. Both were delivered by auto control mode of Zeus machine. Anesthetic agent and O2 consumption, cost and number of adjustments were assessed. Blood samples were obtained preoperatively and at 24, 48 and 72 h after the end of surgery for measuring serum creatinine, BUN, AST and ALT. Twenty-four hour urine samples were collected for 3 consecutive days to measure glucose, microprotein and creatinine for the estimation of creatinine clearance. Results: This study revealed that sevoflurane group had a lower O2, anesthetic consumption and cost than desflurane group. Also both groups had higher levels of serum urea and creatinine together with urinary microproteins and glucose in the first three post-operative days compared to preoperative values which indicates minor tubular insult. However there was no statistically significant difference between the two groups. Conclusion: Sevoflurane is as safe as desflurane when delivered by auto control mode of Zeus machine with decreased anesthetic consumption and cost

Ultrasound guided versus fluroscopic guided pulsed radiofrequency therapy of the stellate ganglion in neuropathic pain: A prospective controlled comparative study

Objective: To assess the efficacy and safety of fluoroscopic–guided versus ultrasound (US)-guided techniques for pulsed radiofrequency (RF) therapy of stellate ganglion for refractory neuropathic pain syndromes. Methods: 40 patients with severe chronic neuropathic pain syndromes, Visual Analogue Scale (VAS) score > 7, with poor response to medical treatment were randomly integrated into 2 groups: Group (F): (20 patients) in whom pulsed R.F. therapy is done under fluoroscopy, group (U): (20 patients) in whom pulsed R.F. therapy is done under US guidance. Results: The current study revealed that there is significant reduction of VAS, and of the medical treatment consumption after the block as compared with pre block values, there is no statistically significant difference between the guidance techniques of RF treatment in pain relief. However, the procedure time was significantly lower in U group. Conclusion: Pulsed R.F. blockade of the stellate ganglion in patients with refractory neuropathic pain syndromes can be done safely and efficiently under the guidance of either ultrasound or fluoroscopy. Both radiological techniques provide similar satisfactory guidance without significant complications. Keywords: Stellate ganglion block (SGB), Neuropathic pain, Pulsed R