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

Effects of topical 2% cyclosporine A on the corneas of dogs subjected to lamellar keratoplasty with a graft of equine pericardium preserved in glycerin: clinical and morphological evaluation Efeitos da aplicação tópica da ciclosporina A a 2% sobre a córnea de cães submetidos à ceratoplastia lamelar com implante de pericárdio de eqüino preservado em glicerina: avaliação clínica e morfológica

The effects of topical 2% cyclosporine A on the cornea of dogs subjected to experimental lamellar keratoplasty with an equine pericardial graft were evaluated. Ten dogs were grouped to be evaluated 3, 7, 15, 30 and 60 days after surgery. Animals received bilateral grafts followed by the application of a 2% cyclosporine A ointment on the left eye (treated eye) and the ointment base on the right eye (control eye) twice a day. The ophthalmic evaluation showed profound bilateral blepharospasm, photophobia and a mucous secretion until the 7th day after surgery; corneal vascularization starting in the limbus was observed as early as the 3rd day in both eyes; opacification and vascularization were more intense in the treated cornea on days 15 and 30 after surgery. Vascularization was still evident on the 60th day, and looked similar in treated eyes and control eyes. The histologic evaluation showed a complete bilateral reepithelization and corneal vascularization three days after the surgery; intense vascularization in both eyes on days 15 and 30, that was much more pronounced in the treated cornea; and a bilateral predominance of polymorphonuclear cells until day 15, and mononuclear cells on day 30. Intact epithelium and stroma with new vessels, as well as graft absorption, in both eyes, were seen on the 60th day. The lamellar keratoplasty with equine pericardial graft was an effective model to study the inflammatory kinetics and corneal vascularization phenomenon. In this study, cyclosporine A did not inhibit corneal vascularization and it did not interfere in the corneal cicatricial process.<br>Foram avaliados os efeitos da ciclosporina A a 2% sobre a córnea de cães submetidos à ceratoplastia lamelar experimental com implante de pericárdio de equino. Dez cães foram divididos em grupos para estudo aos três, sete, 15, 30 e 60 dias de pós-operatório, recebendo implantes bilaterais e em seguida aplicação da pomada com ciclosporina A a 2% no olho esquerdo (olho tratado)e somente a base da mesma pomada no olho direito (olho controle), duas vezes ao dia. À avaliação oftalmológica observou-se, bilateralmente, blefarospasmo, fotofobia e secreção mucosa evidentes até 7 dias de pós-operatório; início de vascularização a partir do limbo aos três dias, bilateralmente; opacidade e vascularização mais intensos em córnea esquerda aos 15 e 30 dias; vascularização ainda evidente, bilateralmente, com aspecto semelhante aos 60 dias. À avaliação histopatológica observou-se, bilateralmente, completa reepitelização e vascularização aos três dias de pós-operatório; vascularização intensa aos 15 e 30 dias, bilateralmente, porém acentuada na córnea esquerda; predomínio de polimorfonucleares até os 15 dias e mononucleares aos 30 dias, bilateralmente; epitélio e estroma íntegros com vasos ainda evidentes e implante incorporado ao estroma, bilateralmente, aos 60 dias. A utilização do implante de pericárdio de equino em ceratoplastias lamelares em cães constitui uma técnica eficaz, aplicável ao estudo da cinética inflamatória e fenômeno de vascularização. A ciclosporina A a 2% não inibiu ou diminuiu a formação vascular na córnea e também não interferiu no processo cicatricial neste estudo