Reducing the carbon footprint of operating rooms through education on the effects of inhalation anesthetics on global warming: A retrospective study.

Environmental concerns, especially global warming, have prompted efforts to reduce greenhouse gas emissions. Healthcare systems, including anesthesia practices, contribute to these emissions. Inhalation anesthetics have a significant environmental impact, with desflurane being the most concerning because of its high global warming potential. This study aimed to educate anesthesiologists on the environmental impact of inhalation anesthetics and assess changes in awareness and practice patterns, specifically reducing desflurane use. This study included data from patients who underwent surgery under general anesthesia 1 month before and after education on the effects of inhalation anesthetics on global warming. The primary endpoint was a change in inhalational anesthetic use. Secondary endpoints included changes in carbon dioxide equivalent (CO2e) emissions, driving equivalent, and medical costs. After the education, desflurane use decreased by 50%, whereas sevoflurane use increased by 50%. This shift resulted in a reduction in the overall amount of inhalational anesthetics used. The total CO2e and driving-equivalent values decreased significantly. The cost per anesthesia case decreased, albeit to a lesser extent than expected. Education on the environmental impact of inhalation anesthetics has successfully altered anesthesiologists' practice patterns, leading to reduced desflurane usage. This change has resulted in decreased CO2e emissions and has had a positive effect on mitigating global warming. However, further research is required to assess the long-term impact of such education and the variability in practice patterns across different institutions.

Percutaneous Endoscopic Debridement and Drainage with Four Different Approach Methods for the Treatment of Spinal Infection.

BACKGROUND: The incidence of spinal infection seems to be increasing in recent years. Percutaneous endoscopic debridement and drainage (PEDD) has become an effective alternative to extensive open surgery. OBJECTIVE: This study reviewed the charter of patients who received PEDD using 4 different approach methods to evaluate the clinical results. STUDY DESIGN: An Institutional Review Board (IRB)-approved retrospective chart review. SETTING: University hospital inpatient referred to our pain clinic. METHODS: A retrospective patient chart analysis of PEDD procedures in spinal infections over a 7-year period was done for the evaluation of structural location, symptoms and signs, etiologic agents, and outcomes. RESULTS: Seventeen patients (11 men and 6 women, mean age 70.4 ± 11.1 years) with spinal infections received PEDD. According to the structural localization of the spinal infections, 6 cases of spondylodiscitis alone, 5 cases of spondylodiscitis with a psoas abscess, one case of spondylodiscitis with an epidural abscess, 4 cases of spondylodiscitis with epidural and psoas abscesses, and one case of spondylodiscitis with a facet joint abscess were found. All patients had preoperative symptoms of unremitting backache and febrile sensation, and signs of paravertebral muscle tenderness and limitation of spine motion. The most common etiologic bacteria were Staphylococcus aureus. Most patients (14/17) improved; the 2 failed patients received a second PEDD after recurrence, and the other received open surgery without re-PEDD. Both the numeric rating scale and Oswestry disability index scores were significantly reduced after PEDD. No complications related to PEDD were found. LIMITATION: This study is limited by its retrospective design. CONCLUSIONS: PEDD using 4 different routes brought immediate pain relief and reduced disability in treating spinal infections, especially in elderly patients with comorbid underlying disorders.Key words: Percutaneous discectomy, psoas abscess, spinal epidural abscess, spondylodiscitis, surgical endoscopy.