Environmentally Sustainable Practices in the Operating Room: A French Nationwide Cross-Sectional Survey of Anaesthesiologists and Nurse Anaesthesiologists.

OBJECTIVE: In France, healthcare facilities account for 7% of greenhouse gas emissions and 3.5% of total waste generation. Operating rooms generate 30% of hospital waste and hence should be a primary focus of environmental sustainability initiatives. The aim of this study was to evaluate environmentally sustainable anaesthesiology practices in France in 2020 and understand the barriers to their adoption. METHODS: An anonymous survey of 28 questions was published online. The website did not record participants' IP addresses. The survey's link was sent by email to anaesthesiologist and anaesthesia nurse members of the French Society of Anesthesia and Intensive Care Medecine (SFAR), in February and June 2020. The survey was closed in August 2020. RESULTS: Of the 10 877 recipients, 1092 (10%) responded to the questionnaire. Waste sorting was organized in 69% of respondents' workplaces (691/1007), and 90% (793/879) of respondents stated that they most often followed the instructions. Sixty-five percent (659/1007) of respondents avoided using the most polluting anaesthetic gases. Thirty-nine percent of respondents (417/1064) had already received environmental sustainability training and 73% (705/972) stated that they wanted more training. The main barriers to the adoption of recycling identified by respondents were staff training (by 70% of respondents, 691/993), budget constraints (66%, 652/993), and a lack of administrative support (60%, 602/993). CONCLUSION: French anaesthesiologists and anaesthesia nurses who responded to the survey are environmentally aware and want to improve sustainable practices in the operating room. More widespread adoption could be achieved by offering training to all healthcare professionals and administrative staff and by creating local environmental focus groups to coordinate actions.

Evolution of Practices in a French Trauma Centre: Decrease in Blood Transfusions and Fresh Frozen Plasma to Red Blood Cell Ratios.

OBJECTIVE: The aim of this study was to describe the evolution of transfusion practices following the introduction of tranexamic acid (TXA) and ROTEMVR in a trauma resuscitation unit (TRU) from a French teaching hospital (FTH). METHODS: This is a single-centre, retrospective study at a TRU from a FTH. All trauma patients aged 18 years or more and transfused with at least 4 red blood cells (RBCs) within 24 hours after trauma, from 2011 to 2016, were included. The primary objective was to analyse transfusion practices over this time period. The secondary objectives aimed at assessing differences between populations according to the fresh frozen plasma (FFP):RBC ratio applied. RESULTS: A total of 122 patients were included. There was a significant decrease in the proportion of patients requiring at least 4 RBCs 24 hours after trauma (9% vs. 3%, P trend < .0001) as well as a decrease in the proportion of patients with a high FFP:RBC ratio (86% vs. 62% at 6 hours, P trend » .0056 and 86% vs. 56% at 24 hours, P trend » .0047). After 2013, fibrinogen was administered to more than 70% of patients and TXA to 100% of them. The observed mortality was lower than the predicted one, irrespective of FFP:RBC ratio. CONCLUSION: An important evolution of practices occurred including a decrease in the proportion of transfusions and use of high FFP:RBC ratios. The origin of these changes is multifactorial, likely including the systematic use of TXA and optimisation of the ROTEM protocol for fibrinogen administration.

Use of Gentamicin for Sepsis and Septic Shock in Anaesthesia-Intensive Care Unit: A Clinical Practice Evaluation.

OBJECTIVE: Numerous cases of gentamicin underdosing have been described in the literature in the context of sepsis and septic shock in anaesthesia-intensive care units (ICU). A survey of clinical practice was conducted with the aim to rationalise the use of gentamicin in the unit. The secondary objective was to propose a corrective formula for adjusting individual dosage. METHODS: A single-centre survey was used to determine the initial dose of gentamicin administered, in an anaesthesia-ICU, during the first hours of sepsis/septic shock. An initial retrospective phase allowed focusing on the points of improvement in terms of prescription. A second prospective phase enabled the evaluation of benefits following the implemented changes. RESULTS: Fifty-one patients were included during the retrospective phase (2014-2015) and 28 patients during the prospective phase (2016-2017). Out-of-guideline prescriptions significantly decreased between these two study periods (i.e., pulmonary infections decreased from 70.5% to 18%, p<0.001) and the mean±standard deviation administered dosage increased from 7.3±1.2 mg kg-1 to 9.5±1.5 mg kg-1 (p<0.001). Nevertheless, the proportion of Cmax (peak plasma concentration) ≥30 mg L-1 and the mean Cmax did not change significantly. A significant association (p<0.05) was found between Cmax, body mass index, haematocrit and creatinine, enabling a corrective formula to be proposed. CONCLUSION: The present study allowed improvement in gentamicin prescription in an anaesthesia-ICU. A Cmax ≥30 mg L-1 remains difficult to achieve, but a Cmax ≥16 mg L-1 could be considered relevant for community infections and would be more attainable. A corrective formula could be used to adjust the dosage.