Global anaesthesia practice using inguinal hernia surgery as a tracer condition: a secondary analysis of an international prospective cohort study

Introduction Restoration of surgical capacity is essential to post-COVID-19 recovery. This study explored the use and safety of anaesthesia options for inguinal hernia surgery, a common tracer condition, to describe current global practice and highlight opportunities to build the capacity of health systems. Methods This is a secondary analysis of an international prospective cohort study of consecutive patients who underwent elective inguinal hernia surgery. We used a consensus process to define generalisable outcomes to measure patient selection, utilisation of hospital capacity and peri-operative safety in patients who received locoregional, spinal or general anaesthesia for their surgery. Results In total, 16,554 patients from 83 countries were included. Locoregional anaesthesia was performed in 1536 (9.2%) of patients, compared with 9165 (55.4%) who had general and 55,853 (35.4%) who had spinal anaesthesia. Patient selection outcomes were comparable across anaesthesia groups. As a measure of hospital capacity, adjusted day-case rates were higher for locoregional anaesthesia (OR 6.62, 95%CI 5.13–8.54, p < 0.001) but not for spinal anaesthesia (OR 0.97, 95%CI 0.84–1.12, p = 0.68) compared with general anaesthesia. Complications were lower in patients who underwent locoregional anaesthesia (OR = 0.67, 95%CI 0.52–0.87, p = 0.001) but not for spinal anaesthesia (OR = 0.90, 95%CI 0.77–1.05, p = 0.167) compared with general anaesthesia after risk adjustment. Discussion This study has filled knowledge gaps of anaesthesia practice in common surgeries across the world. Locoregional and spinal anaesthesia could be adopted as safe options to increase surgical volume when there is limited access to general anaesthesia

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

Susceptibility of Aedes aegypti larvae to temephos and Bacillus thuringiensis var israelensis in integrated control Susceptibilidade de larvas de Aedes aegypti ao tratamento integrado com temephos e Bacillus thuringiensis var israelensis

The susceptibility of field collected Aedes aegypti larvae was evaluated in terms of median lethal time (LT50) and final mortality, when treated with temephos, Bacillus thuringiensis var israelensis as well as mixtures of these two agents. Third instar larvae were shown to be more susceptible than early and late fourth instar ones to the entomopathogen. Survival of some individuals when exposed to temephos suggest possible resistance. Temporal synergism in early fourth instar larvae was detected when they were exposed to mixtures of Bti-temephos. The possibility of this integrated treatment is commented on.<br>A susceptibilidade de larvas de Aedes aegypti coletadas no campo foi avaliada em termos do tempo letal mediano (TL50) e da mortalidade final, quando tratadas com temephos, Bacillus thuringiensis var israelensis ou misturas desses dois agentes. As larvas de terceiro estádio mostraram-se mais suceptíveis ao patógeno do que aquelas no início ou no fim do quarto estádio. A sobrevivência de alguns indivíduos aos tratamentos com temephos permite sugerir a possibilidade de resistência. Foi detectada a existência de sinergismo temporal, quando larvas no início do quarto estádio foram tratadas com as misturas do Bti com o temephos. A possibilidade do tratamento integrado é comentada