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

The comparative and combined effects of nitric oxide and higher alkanes in sensitizing methane oxidation

The comparative and combined effects of nitric oxide (NO) and higher alkanes on methane oxidation were examined by experimentation and kinetic modeling. Experiments were conducted using fuel-lean, lower-alkanes mixtures with NO (0–400 ppm v/v) in an atmospheric flow reactor at residence time of 2 s over the temperature range of 820–950 K. NO was found to greatly promote methane conversion, and its sensitizing effect strengthened with the increasing concentration that was added to the system. The promoting effect of higher alkanes on methane conversion was also evident, particularly at zero or low NO concentrations. A strong dependency of the sensitizing effect on the concentration of higher alkanes present was also observed. The kinetic mechanism from Le Cong et al., performed reasonably well in reproducing the experimental trends. However, the sensitizing propensity of higher alkanes in the presence of NO could not be unambiguously ranked under all conditions. Modification to the kinetic mechanism of Le Cong et al., was attempted. Specifically, the submechanism of C3 peroxy radicals was added, but the modeling results indicated a lower impact on methane conversion than was initially expected. The most sensitive reactions were revealed, and the generalized reaction pathways for methane oxidation sensitized by higher alkanes, with or without the presence of NO, were also proposed, following detailed sensitivity analysis