British journal of anaesthesia
-
Editorial Review
Helping clinicians debrief themselves: a simple how-to guide.
The operating theatre is a dynamic and challenging environment where effective teamwork is essential. Routine clinical debriefings, which involve brief reflections on collaboration to identify successes and areas for improvement, have proved to enhance teamwork, particularly in the operating theatre. However, barriers such as time constraints, conflicting priorities, and a lack of standardised debriefing processes hinder their regular use. Implementation of TALK©, a voluntary self-debriefing method, showed significant improvements in debriefing performance and integration of debriefing into routine practice, although long-term consistency remains a challenge.
-
Multicenter Study
Environmental and financial impacts of perioperative paracetamol use: a multicentre international life-cycle analysis.
Pharmaceuticals account for 19-32% of healthcare greenhouse gas (GHG) emissions. Paracetamol is a common perioperative analgesic agent. We estimated GHG emissions associated with i.v. and oral formulations of paracetamol used in the perioperative period. ⋯ Intravenous paracetamol has 12-fold greater life-cycle carbon emissions than the oral tablet form. Glass vials have higher greenhouse gas emissions than plastic vials. Intravenous administration should be reserved for cases in which oral formulations are not feasible.
-
Multicenter Study Observational Study
Effect of perioperative blood transfusion on preoperative haemoglobin levels as a risk factor for long-term outcomes in patients undergoing major noncardiac surgery: a prospective multicentre observational study.
Preoperative anaemia and red blood cell (RBC) transfusions are associated with poorer clinical outcomes. It is unknown whether perioperative RBC transfusions mediate the relationship between preoperative haemoglobin levels and postoperative outcomes. ⋯ Preoperative haemoglobin levels were significantly associated with 1-yr MACCEs and all-cause mortality. This effect was not mediated by perioperative RBC transfusions. Further research is needed to confirm these findings.
-
Editorial Review
Towards sustainability of volatile anaesthetics: capture and beyond.
The first measures to reduce the environmental harm from volatile anaesthetics are implementation of minimal fresh gas flow strategies and avoidance of desflurane. Although anaesthetic waste gas capture systems generally exert high capturing efficiencies, only about half of volatile anaesthetics used in the operating room are accessible for capture. Industry-sponsored reports promise a reduction of the global warming potential by both incineration and recycling of captured volatile anaesthetics. However, independent high-quality peer-reviewed studies are needed to confirm these findings.
-
Multicenter Study Observational Study
Nitrous Oxide Manifold and Other Reduction of Emissions (NoMoreGas): a multicentre observational study evaluating pre-utilisation loss of nitrous oxide.
Nitrous oxide (N2O) is a potent greenhouse gas that contributes significantly to the healthcare sector's carbon footprint. Pre-utilisation losses of N2O are up to 95%. Decommissioning manifolds can reduce these losses. ⋯ Consistent with other reports, the data demonstrate a substantial discrepancy between the quantities of N2O procured and utilised clinically, indicative of significant pre-utilisation losses. Our findings support the decommissioning of N2O manifolds for environmental and economic benefits.