Environmental impact of intravenous versus oral administration materials for acetaminophen and ketoprofen in a French university hospital: an eco-audit study using a life cycle analysis.

PURPOSE: The combination of acetaminophen with a nonsteroidal anti-inflammatory drug is the cornerstone of perioperative multimodal analgesia. These drugs can be administered intravenously or orally as premedication, consistent with the concept of pre-emptive and preventive analgesia. We aimed to assess the environmental impact of their intravenous and oral administration in a French university hospital. METHODS: We carried out a life cycle assessment to determine the amount of greenhouse gas emissions and depletion of water resources resulting from the oral vs intravenous administration of 1 g acetaminophen and 50 mg ketoprofen. We assessed two schemes of intravenous administration, depending on the use of the same or a different infusion set for each drug. RESULTS: At our centre, the intravenous administration of both drugs was associated with the emission of 444-556 g CO2 equivalent (CO2e), and with 9.8-12.2 L of water waste. The oral administration of both drugs generated 8.36 g of CO2e emissions and consumed 1.16 L of water. At a national level, the switch from intravenous to oral premedication of the drugs could avoid the emission of 2,900-3,700 tons of CO2e and the waste of 58,000-74,000 m3 of water each year. CONCLUSION: This eco-audit indicates that oral administration of acetaminophen and ketoprofen results in significantly lower carbon emissions and water consumption than intravenous administration. These findings highlight the importance of using the oral route for most patients, limiting intravenous administration for those with specific needs because of higher environmental impact and cost.

RéSUMé: OBJECTIF: L'association de l'acétaminophène et d'un anti-inflammatoire non stéroïdien constitue la pierre angulaire de l'analgésie multimodale périopératoire. Ces médicaments peuvent être administrés par voie intraveineuse ou orale en prémédication, conformément au concept d'analgésie préemptive et préventive. Notre objectif était d'évaluer l'impact environnemental de leur administration intraveineuse et orale dans un hôpital universitaire français. MéTHODE: Nous avons réalisé une analyse du cycle de vie pour déterminer la quantité d'émissions de gaz à effet de serre et l'épuisement des ressources en eau résultant de l'administration orale vs intraveineuse de 1 g d'acétaminophène et de 50 mg de kétoprofène. Nous avons évalué deux schémas d'administration intraveineuse, en fonction de l'utilisation du même dispositif de perfusion ou d'un dispositif différent pour chaque médicament. RéSULTATS: Dans notre centre hospitalier, l'administration intraveineuse des deux médicaments a été associée à l'émission de 444 à 556 g d'équivalent CO2 (CO2e) et de 9,8 à 12,2 L d'eaux usées. L'administration orale des deux médicaments a généré 8,36 g de CO2e et consommé 1,16 L d'eau. Au niveau national, le passage de la prémédication intraveineuse à la prémédication orale des médicaments pourrait éviter l'émission de 2900 à 3700 tonnes de CO2e et l'épargne de 58 000 à 74 000 m3 d'eau chaque année. CONCLUSION: Cet éco-audit indique que l'administration orale d'acétaminophène et de kétoprofène entraîne une réduction significative des émissions de carbone et de la consommation d'eau par rapport à une administration par voie intraveineuse. Ces résultats soulignent l'importance d'utiliser la voie orale pour la plupart des patient·es, limitant l'administration intraveineuse pour celles et ceux qui ont des besoins spécifiques en raison de l'impact environnemental et du coût plus élevés.

Fluocinolone Acetonide Implant Injected 1 Month after Dexamethasone Implant for Diabetic Macular Oedema: the ILUVI1MOIS Study.

INTRODUCTION: The aim of this study was to assess the efficacy and safety of fluocinolone acetonide implant (FAci) injected 1 month after the last dexamethasone intravitreal implant (DEXi) in chronic diabetic macular oedema (DME) patients. METHODS: Retrospective multicentric study conducted in pseudophakic patients with chronic DME frequently treated with dexamethasone intravitreal implant (DEXi; time to DME recurrence ≤ 6 months), receiving FAci 1 month after the last DEXi, with at least a 6-month follow-up. Best-corrected visual acuity (BCVA), central macular thickness (CMT) on optical coherence tomography, intraocular pressure (IOP) and additional treatments were assessed on the day of FAci injection (M0), 1 (M1) and 3 months (M3) later and then every 3 months. RESULTS: A total of 41 eyes from 34 patients were included. At M0, patients' mean age was 68.7 ± 9.8 years, the mean DME duration was 63.9 ± 22.9 months, the mean interval between two DEXi was 14.2 ± 3.3 weeks. M12 data were available for 71% of patients. At baseline, the mean BCVA, CMT and IOP were 63.2 ± 16.6 letters, 299.4 ± 103.3 µm, and 16.2 ± 4.5 mmHg, respectively, and remained stable during the follow-up. At M12, 14% of patients required additional intravitreal treatments. CONCLUSION: In pseudophakic patients with chronic DME showing good response to DEXi but requiring repeated injections every < 6 months, switching to FAci 1 month after the last DEXi was effective and safe. Further prospective randomized controlled studies are needed to confirm these findings, and to determine the best interval between the last DEXi and the first FAci.

Inflammatory optic neuropathy in granulomatosis with polyangiitis can mimick isolated idiopathic optic neuritis.

OBJECTIVE: We describe a clinico-radiological presentation of inflammatory optic neuropathy that mimicked optic neuritis. METHODS: Retrospective single-center case series and literature review of optic neuropathy without orbital pseudotumor. RESULTS: Five local patients fulfilled the inclusion criteria. Clinical presentation revealed rapidly progressive severe unilateral visual loss, retrobulbar pain (n = 4), and paralytic strabismus (simultaneous = 2, protracted = 2) without proptosis. Optic nerve abnormality was not appreciated on initial scan review. Patients did not have any general activity of the granulomatosis with polyangiitis. Upon follow-up magnetic resonance imaging and initial imaging review, all patients revealed orbital apex anomalies. Visual acuity improved in three patients who received high-dose intravenous glucocorticosteroids immediately. Relapse was frequent and visual outcome was poor (final vision > 20/40 in two patients only). Literature review identified 16 well-documented cases of granulomatosis with polyangiitis-related isolated optic neuropathies. Magnetic resonance imaging revealed no abnormality (n = 6), optic nerve and/or sheath involvement (n = 9), apex infiltration (n = 3), and/or pachymeningitis (n = 7). CONCLUSION: Granulomatosis with polyangiitis is a rare yet potentially blinding cause of inflammatory optic neuropathy. Optic neuropathy in granulomatosis with polyangiitis may occur in the absence of systemic symptoms of disease activity and is challenging to distinguish from other inflammatory and non-inflammatory disorders affecting visual acuity. Several clinical and imaging clues suggest that optic neuropathy results from the development of an extravascular granulomatous process within the optic nerve sheath in the orbital apex, a place that is difficult to image. In a granulomatosis with polyangiitis patient with unexplained visual loss and a seemingly normal workup (fundoscopy, biology, and imaging), clinician should keep a high index of suspicion.