Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries.

Airway management may be difficult in patients with fixed cervical spine who have undergone previous spine surgery. Among the various techniques, fiber-optic intubation is a preferred method for securing the airway in such situation. However, it has some limitations also like identification of landmarks, especially in a case of distorted anatomy of the airway. To overcome this inadequacy, we used video laryngoscopy as a complement, to guide the tip of bronchoscope beneath the epiglottis into the trachea and thus achieving the goal. We present a case of difficult airway of fixed cervical spine with distorted anatomy in which combined use of fiberoptic and video laryngoscopy was performed to secure the airway. In our opinion, this technique can be utilized for other difficult airway case scenario also.

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Background: Postoperative sore throat (POST) is a common occurrence following general anesthesia with endotracheal intubation although clinicians often regard it as a minor complication. The incidence of POST is estimated to be 21%–65% in different studies. The administration of the drug through aerosol route gained popularity among anesthesiologists with good acceptance from the patients. Hence, we conducted the study with the aim to compare the efficacy of preoperative nebulization with 4% lignocaine and ketamine, in the prevention of POST. Materials and Methods: The study is a prospective, randomized double-blinded study comparing the effects of comparison between preoperative nebulization with ketamine and 4% lignocaine in preventing POST. Hemodynamic parameters, Ramsay sedation score, and visual analog scale (VAS) at 0, 6, and 24 h were observed in both groups. Results: Ketamine nebulization provides better prophylaxis against the occurrence of moderate-to-severe POST as compared to lignocaine. At 0 h, none of the patients had ST in both the groups; at 6 and 24 h, the ST was significantly higher in lignocaine group (28.9% and 8.9%) as compared to ketamine group (8.9% and 0%), with P = 0.04. Mild, moderate, and severe VAS was observed in 51%, 33%, and 16% of Group 1, respectively, while in Group 2, it was observed in 16%, 36%, and 49% of study population, respectively, and this difference was statistically significant. Conclusion: Patients undergoing surgery under general anesthesia with endotracheal intubation were benefitted from ketamine nebulization as prophylaxis against moderate-to-severe POST.

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