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General Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rebecca Fish, Aisling Hogan, Aoife Lowery, Frank McDermott, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Yew-Wei Tan, Thomas Tsang
How is surgical equipment sterilised?The majority of surgical instruments and drapes are sterilised using an autoclave (saturated steam at high pressure), at 134°C, a pressure of 2 atm for a holding time of 3 min. This kills all organisms including viruses and heat-resistant spores. The steam penetration is monitored with the Bowie–Dick test, which should be checked prior to every operation.Dry-heat sterilisation is used for moisture-sensitive instruments and those with fine cutting edges. The tools are heated to 160°C for 1 hour.Ethylene oxide is a highly penetrative gas used to sterilise heat-sensitive equipment (rubber, electrical equipment), and it will kill vegetative bacteria, spores and viruses.Gamma irradiation is used in industry to sterilise large batches of single-use items such as catheters and syringes.
Pancakes
Published in R. Annie Gough, Injury Illustrated, 2020
I recall a case of an architect who took a spill off a roof in 2000. His broken wrist was reduced and cast. The bones healed well, although he had continued pain and issues with the joint. The architect decided to have an arthroscopic procedure to clean up the cartilage and remove any remaining scar tissue in his wrist. During this surgery, an extremity traction tower was used to hold the fingers still, allowing mobility and manipulation within the wrist joint. This device is meant to be cleaned between patients in an autoclave, where extreme heat is used to kill bacteria and other pathogens. The architect was prepped for surgery and placed under general anesthesia. The surgeon scrubbed in, entered the operating room, and asked for the traction tower. He was upset that it wasn't prepped and ready to go. He attempted to take the traction device out of the autoclave, but it was still too hot to touch. The surgeon was frustrated and poured saline on the device in an effort to cool it. With the patient already under anesthesia for some time now, the surgeon elected to begin, setting the architect's fingers into the grips of the device. The patient's arm rested against the stand. The surgeon watched the camera feed as his surgical instruments worked to debride the joint. Eventually, he stopped the surgery, and closed early.
The ophthalmic nurse
Published in Mary E. Shaw, Agnes Lee, Ophthalmic Nursing, 2018
Sterilisation is usually by downward displacement vacuumed autoclave at a temperature of 130°C for 3 minutes, the full cycle lasting 40 minutes in total. Each instrument must be seen to be in good working order, not rusted or damaged, and should be examined under a magnified light source before being sterilised.
Design and evaluation of in situ gel eye drops containing nanoparticles of Gemifloxacin Mesylate
Published in Drug Delivery, 2023
Vishwa J. Kalaria, S. Saisivam, Anas Alshishani, Jameel S. Aljariri Alhesan, Sumit Chakraborty, Mohamed Rahamathulla
The optimized formulation B3 in situ gel formulation containing Gemifloxacin Mesylate Nanoparticles was sterilized in an autoclave. During the sterilization process, a sterile filter paper strip impregnated with spores of Bacillus stearothermophilus as a biological indicator packed in an aluminum foil was also subjected to autoclave sterilization along with optimized formulation . The Biological indicator was transferred aseptically into petriplate containing nutrient agar medium and incubated at 37° C for 24 hrs. The Petriplate did not show any growth of Bacillus stearothermophilus. This proves that autoclave sterilization is proper. Apart from this, the sterilize optimized formulation was also subjected to test for sterility as per Indian Pharmacopeia (2018). The formulation passed the test for sterility proving that there is no microbial contamination.
A γ-cyclodextrin-based metal–organic framework (γ-CD-MOF): a review of recent advances for drug delivery application
Published in Journal of Drug Targeting, 2022
Asma Hamedi, Anastasia Anceschi, Alessia Patrucco, Mahdi Hasanzadeh
Interestingly, the smaller cubic crystals of γ-CD-MOF (5–10 μm) were prepared using an innovative modified vapour diffusion method by adding cetyltrimethylammonium bromide (CTAB) as a surfactant. Also, nanocrystals (200–300 nm) could be obtained by adding both CTAB and methanol during the generation process [31–33]. The γ-CD-MOF crystal size could be regulated by changing parameters such as the reactant concentrations, temperatures, time, γ-CD ratio to KOH, CTAB concentrations, and solvents [34]. Since CTAB is toxic and carries a venture of sample pollution, it was demonstrated that it is possible to obtain porous cubic crystals using a modified vapour diffusion route without adding any surfactant or emulsifier [35]. Briefly, the γ-CD-MOF cubic crystals (10–15 μm) were prepared by dissolving 1.0 mmol of γ-CD and 8.0 mmol of KOH in 20 ml of deionised water. After filtering, a vessel containing the product is moved within a Teflon autoclave including methanol, followed by vapour diffusion of MeOH at 80 °C for 15 h. After cooling the autoclave, the crystals were washed with MeOH and dried at 40 °C in an oven for 6 h. As a result, increasing the pressure and temperature inside the autoclave reduced the crystal formation time from 7 days to 15 h and the size of crystals varies from 200–400 μm to 10–15 μm.
Formulation, manufacturing and regulatory strategies for extracellular vesicles-based drug products for targeted therapy of central nervous system diseases
Published in Expert Review of Precision Medicine and Drug Development, 2020
Kaining Zhi, Asit Kumar, Babatunde Raji, Harry Kochat, Santosh Kumar
Autoclave, also called steam sterilization, is a commonly used process to sterilize drug products, medical equipment, and surgical supplies [117]. In 2020, Schulz et al. from Fuhrmann’s group reported the 1st thermal stability study on EVs [118]. In this publication, Schultz and colleagues incubated EVs from B lymphoblastoid cells and outer membrane vesicles (OMVs) SBSr073 myxobacteria, at 37, 50, 70 and 100°C. To test any changes regarding EVs integrity, they tested size distribution for aggregation, particle concentration for the cargo loading, and protein concentration for membrane breakage. In general, OMVs have better thermal stability than EVs. However, EVs are very stable under 37°C. With increasing temperature to 100°C, EVs showed decreased stability with increased temperature and longer exposure time. Schulz and colleagues also used an autoclave cycle on both EVs and OMVs (121°C for 20 min at 2 bar) with the following cell uptake test. The results showed that both EVs and OMVs had relatively lower cell updates compared to control. EVs showed approximately 50% update rate compared to control, while OMVs showed roughly 70% uptake. This study provides important information that traditional autoclave may be suitable for EVs based products but the cycle needs to be much shorter.