A techno-economic-societal assessment of recovery of waste volatile anaesthetics

How to Personalize General Anesthesia-A Prospective Theoretical Approach to Conformational Changes of Halogenated Anesthetics in Fire Smoke Poisoning

Smoke intoxication is a central event in mass burn incidents, and toxic smoke acts at different levels of the body, blocking breathing and oxygenation. The majority of these patients require early induction of anesthesia to preserve vital functions. We studied the influence of hemoglobin (HMG) and myoglobin (MGB) blockade by hydrochloric acid (HCl) in an interaction model with gaseous anesthetics using molecular docking techniques. In the next part of the study, molecular dynamics (MD) simulations were performed on the top-scoring ligand-receptor complexes to investigate the stability of the ligand-receptor complexes and the interactions between ligands and receptors in more detail. Through docking analysis, we observed that hemoglobin creates more stable complexes with anesthetic gases than myoglobin. Intoxication with gaseous hydrochloric acid produces conformational and binding energy changes of anesthetic gases to the substrate (both the pathway and the binding site), the most significant being recorded in the case of desflurane and sevoflurane, while for halothane and isoflurane, they remain unchanged. According to our theoretical model, the selection of anesthetic agents for patients affected by fire smoke containing hydrochloric acid is critical to ensure optimal anesthetic effects. In this regard, our model suggests that halothane and isoflurane are the most suitable choices for predicting the anesthetic effects in such patients when compared to sevoflurane and desflurane.

The environmental impact of surgery: A systematic review

BACKGROUND

Climate change is a significant public health threat. Health care comprises 10% of greenhouse gas emissions in the United States, where surgery is especially resource intensive. We did a systematic review to assess and summarize the published evidence of the environmental impact of surgery.

METHODS

We searched Medline, Embase, Web of Science, and GreenFILE databases for publications that report any environmental impact measure by all surgical subspecialties, including anesthesia. Inclusion criteria were published in English, original research, and passed peer review. Because data were heterogeneous and the aim was broad, we conducted a qualitative summary of data. Where possible, we compare impact measures.

RESULTS

In the study, 167 articles were identified by our search strategy and reviewed, of which 55 studies met criteria. Eight were about anesthesia, 27 about operating room waste, and 6 were life cycle assessments. Other topics include carbon footprint and greenhouse gas emissions. Nine papers fell into 2 or more categories. Overall, the operating room is a significant source of emissions and waste. Using anesthetic gases with low global warming potential reduces operating room emissions without compromising patient safety. Operating room waste is often disposed of improperly, often due to convenience or knowledge gaps. There are environmental benefits to replacing disposable materials with reusable equivalents, and to proper recycling. Surgeons can help implement these changes at their institution.

CONCLUSION

Although there is a clear need to lower the carbon footprint of surgery, the quality of research with which to inform protocol changes is deficient overall. Our attempt to quantify surgery's carbon footprint yielded heterogeneous data and few standardized, actionable recommendations. However, this data serves as a starting point for important future initiatives to decrease the environmental impact of surgery.

Mechanisms, status, and challenges of thermal hydrolysis and advanced thermal hydrolysis processes in sewage sludge treatment

Sewage sludge management has garnered interest in both academia and industry due to the challenges of overpopulation and its potential as a bioenergy source. Thermal hydrolysis is a promising technology for sludge pre-treatment prior to anaerobic digestion to enhance biogas production. However, the technology is facing two main problems; the dark colour of sludge can affect UV disinfection and the formation of methanogenesis inhibitors such as free ammonia and refractory compounds have a significant impact on methane production in anaerobic digestion processes. Advanced thermal hydrolysis, which is an oxidative thermal hydrolysis process, has been introduced to overcome these challenges. This study provides a comprehensive review of the mechanisms and reactions which occur during the hydrothermal hydrolysis and advanced thermal hydrolysis processes. Technical and implementation challenges of both technologies are discussed. Additionally, the prospects of the technologies are assessed through their technology readiness levels. An assessment of the relevant literature is also provided to illuminate the aspects in which research gaps exist and areas where additional studies could be performed.

Utilization of O/S-doped graphene nanoclusters for ultrasensitive detection of flurane derivatives-DFT investigations

Nanocluster based drug delivery systems are very useful in modern medical treatment and interaction mechanism of desflurane (DES), isoflurane ISO), sevoflurane (SEV) over carboxyl substituted graphene-doped with O and S atoms were investigated in the present study. Different electronic and chemical properties of adsorbed desflurane, isoflurane and sevoflurane with nanoclusters are analyzed. To track the drugs, SERS is used as an efficient method and drug's detection was analyzed using SERS. DES's energy over GQD-S is greater than that over GQD-O nanocluster and for ISO and SEV, adsorption energies over the O/S nanoclusters are same. The title drugs work on the reactives sites and got adsorbed. For ISO, there is an increase in fluorine atom charges and for DES and SEV, the fluorine atom charge decreases due to adsorption in both O/S nanoclusters. Changes in chemical descriptors are identified for the sensing property of drug-nanoclusters.Communicated by Ramaswamy H. Sarma.

Enrichment of surface oxygen functionalities on activated carbon for adsorptive removal of sevoflurane

Activated carbons have been reported to be useful for adsorptive removal of the volatile anaesthetic sevoflurane from a vapour stream. The surface functionalities on activated carbons could be modified through aqueous oxidation using oxidising solutions to enhance the sevoflurane adsorption. In this study, an attempt to oxidise the surface of a commercial activated carbon to improve its adsorption capacity for sevoflurane was conducted using 6 mol/L nitric acid, 2 mol/L ammonium persulfate, and 30 wt per cent (wt%) of hydrogen peroxide (H₂O₂). The adsorption tests at fixed conditions (bed depth: 10 cm, inlet concentration: 528 mg/L, and flow rate: 3 L/min) revealed that H₂O₂ oxidation gave desirable sevoflurane adsorption (0.510 ± 0.005 mg/m²). A parametric study was conducted with H₂O₂ to investigate the effect of oxidation conditions to the changes in surface oxygen functionalities by varying the concentration, oxidation duration, and temperature, and the Conductor-like Screening Model for Real Solvents (COSMO-RS) was applied to predict the interactions between oxygen functionalities and sevoflurane. The H₂O₂ oxidation incorporated varying degrees of both surface oxygen functionalities with hydrogen bond (HB) acceptor and HB donor characters under the studied conditions. Oxidised samples with enriched oxygen functionalities with HB acceptor character and fewer HB donor character exhibited better adsorption capacity for sevoflurane. The presence of a high amount of oxygen functional groups with HB donor character adversely affected the sevoflurane adsorption despite the enrichment of oxygen functional groups with HB acceptor character that have a higher tendency to adsorb sevoflurane.

Breakthrough analysis of continuous fixed-bed adsorption of sevoflurane using activated carbons

The inhalational anaesthetic agent - sevoflurane is widely employed for the induction and maintenance of surgical anaesthesia. Sevoflurane possesses a high global warming potential that imposes negative impact to the environment. The only way to resolve the issue is to remove sevoflurane from the medical waste gas before it reaches the atmosphere. A continuous adsorption study with a fixed-bed column was conducted using two commercial granular activated carbons (E-GAC and H-GAC), to selectively remove sevoflurane. The effect of bed depth (Z, 5-15 cm), gas flow rate (Q, 0.5-6.0 L/min) and inlet sevoflurane concentration (C₀, ∼55-700 mg/L) was investigated. E-GAC demonstrated ∼60% higher adsorption capacity than H-GAC under the same operating conditions. Varying the levels of Z, Q and C₀ showed significant differences in the adsorption capacities of E-GAC, whereas only changing the C₀ level had significant differences for H-GAC. Three breakthrough models (Adams-Bohart, Thomas, and Yoon-Nelson) and Bed-depth/service time (BDST) analysis were applied to predict the breakthrough characteristics of the adsorption tests and determine the characteristic parameters of the column. The Yoon-Nelson and Thomas model-predicted breakthrough curves were in good agreement with the experimental values. In the case of the Adams-Bohart model, a low correlation was observed. The predicted breakthrough time (t_b) based on kinetic constant (k_BDST) in BDST analysis showed satisfactory agreement with the measured values. The results suggest the possibility of designing, scaling up and optimising an adsorption system for removing sevoflurane with the aid of the models and BDST analysis.