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

Postnatal development of baroreflex sensitivity in infancy

Baroreflex sensitivity (BRS) using spontaneous sequence analysis in the time domain is not fully applicable in infancy, as the time delay for heart period to change (heart period delay, HPD) after an arterial pressure change is unknown. We estimated and compared HPD and BRS in the frequency (BRSsp, HPDsp) and time domains (BRSseq, HPDseq) from systolic blood pressure (SBP) and heart period fluctuations. Continuous SBP, using photoplethysmography, and heart period measurements were performed on 30 term infants at 2–4 weeks, 2–3 months and 5–6 months postnatal age. Cross-spectral analysis between SBP and heart period fluctuations was used to estimate BRSsp and HPDsp. Spontaneous sequence analysis was used to estimate BRS using a fixed beat delay of 1–12 beats (BRSseq) or a variable delay identified by a novel method accounting for epoch–epoch variability in HPD (BRSseqvar). HPDsp averaged 3.4 s (∼7 beats); BRSsp averaged 11.4 ms mmHg−1. BRSseq and BRSseqvar were consistently lower than BRSsp (P < 0.05), but the three BRS estimates were strongly correlated using a HPD of ∼5–6 beats. BRSseqvar resulted in the average estimate (8.9 ms mmHg−1) closest to BRSsp and overall had the strongest correlation with BRSsp (R2= 0.61; P < 0.001). All three BRS estimates increased progressively with postnatal age, with BRSsp averaging 6.4, 10.5 and 16.0 ms mmHg−1 at 2–4 weeks, 2–3 months and 5–6 months, respectively (P < 0.05). Accounting for the HPD of infancy provides estimates of BRS in the time domain that closely parallel spectral estimates, and provides a novel analytical tool to assess normal development and dysfunction of the baroreflex in infants