Anaesthesia and climate change: time to wake up? A rapid qualitative appraisal exploring the views of anaesthetic practitioners regarding the transition to TIVA and the reduction of desflurane.

BACKGROUND: The National Health Service (NHS) has pledged to reach carbon net-zero by 2040. In alignment with this goal, a London hospital's anaesthesia department is actively reducing desflurane use and transitioning towards total intravenous anaesthesia (TIVA) as a sustainable alternative, contributing to environmentally responsible practices within the healthcare sector. METHODS: We conducted a rapid qualitative appraisal through online interviews with 17 anaesthetic practitioners to explore their perspectives regarding this climate change mitigation strategy. Data analysis was undertaken through the use of rapid appraisal sheets and a framework analysis method. RESULTS: Participants highlighted the disadvantages of TIVA, including the increased effort, heightened monitoring requirements, operational challenges, and a lack of clinical confidence associated with its use. Despite these reservations, participants acknowledged TIVA's potential to reduce postoperative nausea. There were perceptions that senior staff members might resist this change due to habits and scepticism over its impact on climate change. To facilitate greater TIVA adoption, participants recommended enhanced training, the implementation of a dashboard to raise awareness of greenhouse gas (GHG) emissions, and the presence of strong climate change leadership within the department. Participants believed that a shift to TIVA should be followed by specific measures such as addressing waste management which is crucial for GHG reduction, emphasising the perceived link between waste and emissions. CONCLUSIONS: The evaluation examines stakeholder attitudes, perceptions, and behaviours, focusing on transitioning from desflurane to TIVA. The study highlights the importance of staff engagement, organisational support, and underscores the crucial role that healthcare practitioners and leadership play in fostering sustainability within the healthcare sector.

Anaesthesia and COVID-19: infection control.

The world is currently facing an unprecedented healthcare crisis caused by a pandemic novel beta coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The pathogen is spread by human-to-human transmission via droplets exposure and contact transfer, causing mild symptoms in the majority of cases, but critical illness, bilateral viral pneumonia, and acute respiratory distress syndrome (ARDS) in a minority. Currently, controlling infection to prevent the spread of SARS-CoV-2 is the primary public healthcare intervention used. The pace of transmission and global scale of SARS-CoV-2 infections has implications for strategic oversight, resource management, and responsiveness in infection control. This article presents a summary of learning points in epidemiological infection control from the SARS epidemic, alongside a review of evidence connecting current understanding of the virologic and environmental contamination properties of SARS-CoV-2. We present suggestions for how personal protective equipment policies relate to the viral pandemic context and how the risk of transmission by and to anaesthetists, intensivists, and other healthcare workers can be minimised.

Development of an ultrasound phantom for spinal injections with 3-dimensional printing.

BACKGROUND AND OBJECTIVES: This report describes a method for producing anatomically detailed, low-cost ultrasound phantoms of the spine with 3-dimensional printing. An implementation that involves representing a portion of the lumbar spine and the ligamentum flavum with 2 different printing materials and the surrounding soft tissues with agar gel is presented. METHODS: A computed tomography image volume of a patient with normal spinal anatomy was segmented to isolate the spine. Segments representing the ligamentum flavum and a supporting pedestal were digitally added, and the result was printed with a 3-dimensional printer. The printed spine was embedded in agar gel as a soft tissue component. Ultrasound images of the phantom were acquired and compared with those acquired from a human patient. RESULTS: The sonographic appearances of the phantom compared favorably with those observed from the human patient. The soft tissue component was suitable for needle insertions and could be remade replacing the agar. CONCLUSIONS: Ultrasound phantoms that are derived directly from patient anatomy have strong potential as learning tools for ultrasound-guided spinal insertions, and they could be used as preprocedural planning tools in cases involving pathologies, implants, or abnormal anatomies. Three-dimensional printing is a promising method for producing low-cost phantoms with designs that can be readily shared across clinical institutions.

Improving the Peri-operative care of Patients by instituting a 'Block Room' for Regional Anaesthesia.

Regional anaesthesia has multiple known benefits over general anaesthesia alone, but requires time and expertise for its application. This study aimed to decrease anaesthetic time and increase total surgical operative time by instituting a 'block room' where regional anaesthesia nerve blocks could be provided by expert anaesthetists in regular scheduled sessions. A baseline audit showed that 2 hours per day was spent on performing nerve blocks. Development of the block room allowed nerve blocks to be performed in parallel to surgical operations, reducing the mean anaesthetic control time from 44 mins to 27 mins. This freed time for an extra operative case per day. In addition, pooling of expertise to one site has allowed excellent teaching opportunities for anaesthetic trainees, and a specific training programme for regional anaesthesia is being produced. In conclusion, instituting a block room has improved the efficiency of our theatre complex, and improved the service deliverable to our patients.

Thirty percent of patients have moderate to severe pain 24 hr after ambulatory surgery: a survey of 5,703 patients.

PURPOSE: Postoperative pain is the commonest reason for delayed discharge and unanticipated hospital admission after ambulatory surgery. We investigated the severity of pain at 24 hr postoperatively and determined the most painful procedures. The need for further medical advice and clarity of postoperative analgesia instructions were also studied. METHODS: Five thousand seven hundred and three ambulatory surgical patients were telephoned 24 hr postoperatively. Patients graded their pain using the ten-point self-assessing verbal scale (0 = no pain, 10 = worst pain). Data were analyzed in two groups, those with moderate to severe pain (pain score 4-10) and those with no or mild pain (0-3). RESULTS: Thirty percent of patients (1,495/5,703) had moderate to severe pain. Microdiscectomy, laparoscopic cholecystectomy, shoulder surgery, elbow/hand surgery, ankle surgery, inguinal hernia repair, and knee surgery were identified as the procedures causing most pain at 24 hr. 13.2% of patients needed medical advice by telephone, 1.4% made an unplanned visit to a doctor while the rate of readmission to the hospital was 0.08%. Ninety-eight percent found postoperative instruction sheets and advice helpful. Eighty-eight percent of patients indicated that analgesic instructions were absolutely clear. CONCLUSION: This study has identified the more painful common ambulatory surgical procedures which will allow take home analgesia to be tailored according to individual procedures. Further improvement in analgesic instructions may help in better pain management of ambulatory surgery patients.

Pain management in ambulatory surgery.

Successful ambulatory surgery is dependent on analgesia that is effective, has minimal adverse effects, and can be safely managed by the patient at home after discharge. A number of studies have identified that the provision of effective postoperative analgesia is inadequate for a significant proportion of patients. The following discussion details the current available analgesic options for ambulatory surgery patients and the rationale for their use. Preemptive analgesia should be given to all patients unless there are specific contraindications. Consideration should be given to the use of long-acting oral COX-2 selective nonsteroidal anti-inflammatory drugs (NSAIDs) and long-acting oral opioids to treat postoperative pain. A standardized multimodal postdischarge analgesic regimen tailored to the patient's expected postoperative pain levels should be prescribed. Patient follow-up by telephone questionnaire will confirm those surgical procedures that result in mild or moderate-to-severe postoperative pain and the effectiveness of treatment plans.