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

Efeitos do trimetilaminoetano (TES) e ringer lactato em sêmen de macacos-aranha mantidos em cativeiro ( Ateles paniscus e A. marginatus)

The performances of the diluents TES and CEBRAN II were compared as cryopreservatives of semen from non human primates of the genus Ateles. The experiment was carried out using one Ateles marginatus and two Ateles paniscus specimens, males and adults, maintained in the same captivity conditions at the National Center of Primates (CENP-SVS/MS). The animals were subjected to clinical and andrological examinations - testicular biometry - before the semen collection by eletroejaculation. Evaluations of motility and forward movement in the fresh semen were made. Semen were made dilution was made with the diluents TES and CEBRAN II. The ejaculates were diluted with the diluents (2:1proportion), packed in 0.25mL plastic straws and cryopreserved in liquid nitrogen. After thawing, the packed ejaculates were appraised in thermo resistance test (TTR). The averages of volume and concentration were, respectively, 1.94mL (0.83) and 3,020,000 sptz/mL (275.97). The pH 8 and seminal coagulation were observed in all samples. The results suggest that the TES diluent presents better efficiency in the preservation of Ateles semen than CEBRAN II