from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import cm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, HRFlowable, PageBreak
)
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import KeepTogether

# ── Color Palette ──────────────────────────────────────────────
DARK_GREEN    = colors.HexColor("#1B5E20")
MID_GREEN     = colors.HexColor("#2E7D32")
LIGHT_GREEN   = colors.HexColor("#A5D6A7")
TEAL          = colors.HexColor("#00695C")
CYAN_LIGHT    = colors.HexColor("#E0F7FA")
AMBER         = colors.HexColor("#E65100")
AMBER_LIGHT   = colors.HexColor("#FFF3E0")
BLUE_DARK     = colors.HexColor("#0D47A1")
BLUE_LIGHT    = colors.HexColor("#E3F2FD")
PURPLE        = colors.HexColor("#4A148C")
PURPLE_LIGHT  = colors.HexColor("#F3E5F5")
RED_DARK      = colors.HexColor("#B71C1C")
RED_LIGHT     = colors.HexColor("#FFEBEE")
GOLD          = colors.HexColor("#F57F17")
WHITE         = colors.white
NEAR_BLACK    = colors.HexColor("#1A1A1A")
LIGHT_GREY    = colors.HexColor("#F5F5F5")
DARK_GREY     = colors.HexColor("#424242")

PAGE_W, PAGE_H = A4
MARGIN = 1.8 * cm

doc = SimpleDocTemplate(
    "/home/daytona/workspace/green-anesthesia/Green_Anesthesia_Notes.pdf",
    pagesize=A4,
    leftMargin=MARGIN, rightMargin=MARGIN,
    topMargin=MARGIN, bottomMargin=MARGIN,
    title="Green Anesthesia – Comprehensive Notes",
    author="Orris AI"
)

# ── Styles ─────────────────────────────────────────────────────
base = getSampleStyleSheet()

def style(name, parent="Normal", **kwargs):
    return ParagraphStyle(name, parent=base[parent], **kwargs)

S = {
    "cover_title": style("cover_title", "Title",
        fontSize=28, textColor=WHITE, alignment=TA_CENTER, leading=34, spaceAfter=6),
    "cover_sub": style("cover_sub",
        fontSize=13, textColor=LIGHT_GREEN, alignment=TA_CENTER, leading=18, spaceAfter=4),
    "cover_tag": style("cover_tag",
        fontSize=10, textColor=WHITE, alignment=TA_CENTER, leading=14),

    "section_h": style("section_h",
        fontSize=13, textColor=WHITE, leading=18, spaceBefore=4, spaceAfter=2,
        fontName="Helvetica-Bold", leftIndent=0),
    "subsec_h": style("subsec_h",
        fontSize=11, textColor=DARK_GREEN, leading=16, spaceBefore=8, spaceAfter=3,
        fontName="Helvetica-Bold"),
    "body": style("body",
        fontSize=9.5, textColor=NEAR_BLACK, leading=15, spaceAfter=4,
        alignment=TA_JUSTIFY),
    "bullet": style("bullet",
        fontSize=9.5, textColor=NEAR_BLACK, leading=14, spaceAfter=3,
        leftIndent=14, bulletIndent=4),
    "table_hdr": style("table_hdr",
        fontSize=9, textColor=WHITE, fontName="Helvetica-Bold",
        alignment=TA_CENTER, leading=13),
    "table_cell": style("table_cell",
        fontSize=8.8, textColor=NEAR_BLACK, leading=13, alignment=TA_LEFT),
    "table_cell_c": style("table_cell_c",
        fontSize=8.8, textColor=NEAR_BLACK, leading=13, alignment=TA_CENTER),
    "highlight_green": style("highlight_green",
        fontSize=9.5, textColor=DARK_GREEN, fontName="Helvetica-Bold",
        leading=14, leftIndent=10, spaceAfter=3),
    "highlight_amber": style("highlight_amber",
        fontSize=9.5, textColor=AMBER, fontName="Helvetica-Bold",
        leading=14, leftIndent=10, spaceAfter=3),
    "box_title": style("box_title",
        fontSize=10, textColor=WHITE, fontName="Helvetica-Bold",
        alignment=TA_CENTER, leading=14, spaceAfter=2),
    "box_body": style("box_body",
        fontSize=9, textColor=NEAR_BLACK, leading=13, alignment=TA_JUSTIFY),
    "footer": style("footer",
        fontSize=7.5, textColor=DARK_GREY, alignment=TA_CENTER),
}

# ── Helper: Section Header Bar ─────────────────────────────────
def sec_bar(title, bg=MID_GREEN):
    t = Table([[Paragraph(title, S["section_h"])]],
              colWidths=[PAGE_W - 2 * MARGIN])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), bg),
        ("ROUNDEDCORNERS", [4]),
        ("TOPPADDING", (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING", (0,0), (-1,-1), 10),
    ]))
    return t

# ── Helper: Colored Info Box ───────────────────────────────────
def info_box(title, items, title_bg=TEAL, box_bg=CYAN_LIGHT):
    rows = [[Paragraph(title, S["box_title"])]]
    for item in items:
        rows.append([Paragraph(item, S["box_body"])])
    t = Table(rows, colWidths=[PAGE_W - 2 * MARGIN])
    ts = TableStyle([
        ("BACKGROUND", (0,0), (0,0), title_bg),
        ("BACKGROUND", (0,1), (-1,-1), box_bg),
        ("BOX", (0,0), (-1,-1), 0.8, title_bg),
        ("INNERGRID", (0,0), (-1,-1), 0.3, colors.HexColor("#B2DFDB")),
        ("TOPPADDING", (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING", (0,0), (-1,-1), 8),
        ("RIGHTPADDING", (0,0), (-1,-1), 8),
    ])
    t.setStyle(ts)
    return t

# ── Content ────────────────────────────────────────────────────
story = []

# ════════════════════════════════════════════════════════════════
# PAGE 1  –  COVER
# ════════════════════════════════════════════════════════════════
cover_bg = Table(
    [[Paragraph("GREEN ANESTHESIA", S["cover_title"])],
     [Paragraph("Environmentally Sustainable Anaesthesia Practice", S["cover_sub"])],
     [Spacer(1, 0.3*cm)],
     [Paragraph("A Comprehensive Reference for Clinicians", S["cover_tag"])],
     [Spacer(1, 0.2*cm)],
     [Paragraph("June 2026  |  Orris AI Notes", S["cover_tag"])],
    ],
    colWidths=[PAGE_W - 2 * MARGIN]
)
cover_bg.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,-1), DARK_GREEN),
    ("TOPPADDING", (0,0), (-1,-1), 18),
    ("BOTTOMPADDING", (0,0), (-1,-1), 18),
    ("LEFTPADDING", (0,0), (-1,-1), 16),
    ("RIGHTPADDING", (0,0), (-1,-1), 16),
    ("ROUNDEDCORNERS", [8]),
]))
story.append(cover_bg)
story.append(Spacer(1, 0.5*cm))

# Intro paragraph
story.append(Paragraph(
    "Green Anesthesia refers to the set of clinical practices, policy frameworks, and cultural shifts in anesthesiology "
    "aimed at reducing the environmental footprint of perioperative care — without compromising patient safety. "
    "Healthcare globally accounts for ~5% of greenhouse gas (GHG) emissions; anesthesia, particularly volatile agents, "
    "is a disproportionate contributor. This document synthesizes key concepts, current international guidelines, "
    "practical strategies, and emerging evidence.",
    S["body"]
))
story.append(Spacer(1, 0.3*cm))

# Why It Matters box
story.append(info_box(
    "  WHY IT MATTERS — Key Statistics",
    [
        "• Healthcare contributes ~5% of global GHG emissions (comparable to the aviation industry).",
        "• Inhalational anaesthetics alone account for ~3% of NHS healthcare emissions (UK data).",
        "• Perioperative services generate ~30% of hospital solid waste and the majority of hospital carbon footprint.",
        "• Desflurane has a Global Warming Potential (GWP) ~2,500× that of CO₂; sevoflurane ~130×; isoflurane ~510×.",
        "• Nitrous oxide (N₂O) has an atmospheric lifetime of 123 years and is a potent ozone-depleting substance.",
        "• The WFSA 2022 Global Consensus Statement calls action on green anesthesia a global imperative.",
    ],
    title_bg=TEAL, box_bg=CYAN_LIGHT
))
story.append(Spacer(1, 0.3*cm))

# Three Pillars
story.append(Paragraph("Three Foundational Pillars (WFSA 2022)", S["subsec_h"]))
pillars = [
    [Paragraph("Pillar", S["table_hdr"]), Paragraph("Core Principle", S["table_hdr"])],
    [Paragraph("Patient Safety First", ParagraphStyle("p1", parent=S["table_cell"], textColor=DARK_GREEN, fontName="Helvetica-Bold")),
     Paragraph("Sustainable practices must NEVER compromise patient safety or clinical outcomes.", S["table_cell"])],
    [Paragraph("Global Equity", ParagraphStyle("p2", parent=S["table_cell"], textColor=BLUE_DARK, fontName="Helvetica-Bold")),
     Paragraph("High-, middle- and low-income countries should support one another; green anesthesia is not a privilege.", S["table_cell"])],
    [Paragraph("Institutional Mandate", ParagraphStyle("p3", parent=S["table_cell"], textColor=AMBER, fontName="Helvetica-Bold")),
     Paragraph("Healthcare systems must be mandated and monitored to reduce their contribution to global warming.", S["table_cell"])],
]
pt = Table(pillars, colWidths=[4.5*cm, PAGE_W - 2*MARGIN - 4.5*cm])
pt.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), MID_GREEN),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [LIGHT_GREY, BLUE_LIGHT]),
    ("BOX", (0,0), (-1,-1), 0.8, MID_GREEN),
    ("INNERGRID", (0,0), (-1,-1), 0.4, colors.HexColor("#C8E6C9")),
    ("TOPPADDING", (0,0), (-1,-1), 6), ("BOTTOMPADDING", (0,0), (-1,-1), 6),
    ("LEFTPADDING", (0,0), (-1,-1), 8), ("RIGHTPADDING", (0,0), (-1,-1), 8),
    ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
]))
story.append(pt)

story.append(PageBreak())

# ════════════════════════════════════════════════════════════════
# PAGE 2  –  VOLATILE AGENTS + GWP + GAS FLOW
# ════════════════════════════════════════════════════════════════
story.append(sec_bar("  VOLATILE ANAESTHETIC AGENTS & ENVIRONMENTAL IMPACT", DARK_GREEN))
story.append(Spacer(1, 0.25*cm))

story.append(Paragraph(
    "Volatile halogenated anaesthetics are potent greenhouse gases. Once exhaled and scavenged, they are typically "
    "vented to the atmosphere. Their environmental impact is determined by (a) Global Warming Potential (GWP), "
    "(b) atmospheric lifetime, and (c) the clinical dose required (MAC).",
    S["body"]
))
story.append(Spacer(1, 0.2*cm))

# GWP comparison table
story.append(Paragraph("Comparative Environmental Profile of Volatile Agents", S["subsec_h"]))
gwp_data = [
    [Paragraph("Agent", S["table_hdr"]),
     Paragraph("GWP (100-yr)", S["table_hdr"]),
     Paragraph("Atm. Lifetime", S["table_hdr"]),
     Paragraph("MAC (%)", S["table_hdr"]),
     Paragraph("Ozone Depletion", S["table_hdr"]),
     Paragraph("Recommendation", S["table_hdr"])],
    [Paragraph("Desflurane", ParagraphStyle("df", parent=S["table_cell_c"], textColor=RED_DARK, fontName="Helvetica-Bold")),
     Paragraph("~2,500", S["table_cell_c"]), Paragraph("14 years", S["table_cell_c"]),
     Paragraph("6–8%", S["table_cell_c"]), Paragraph("Negligible", S["table_cell_c"]),
     Paragraph("AVOID / Discontinue", ParagraphStyle("df2", parent=S["table_cell_c"], textColor=RED_DARK, fontName="Helvetica-Bold"))],
    [Paragraph("Nitrous Oxide", ParagraphStyle("n2o", parent=S["table_cell_c"], textColor=AMBER, fontName="Helvetica-Bold")),
     Paragraph("~265", S["table_cell_c"]), Paragraph("123 years", S["table_cell_c"]),
     Paragraph("~100%", S["table_cell_c"]), Paragraph("YES – significant", ParagraphStyle("oz", parent=S["table_cell_c"], textColor=RED_DARK)),
     Paragraph("Minimize / Avoid", ParagraphStyle("n2o2", parent=S["table_cell_c"], textColor=AMBER, fontName="Helvetica-Bold"))],
    [Paragraph("Isoflurane", S["table_cell_c"]),
     Paragraph("~510", S["table_cell_c"]), Paragraph("3.2 years", S["table_cell_c"]),
     Paragraph("1.2%", S["table_cell_c"]), Paragraph("Minimal", S["table_cell_c"]),
     Paragraph("Use with low-flow", S["table_cell_c"])],
    [Paragraph("Sevoflurane", ParagraphStyle("sevo", parent=S["table_cell_c"], textColor=DARK_GREEN, fontName="Helvetica-Bold")),
     Paragraph("~130", S["table_cell_c"]), Paragraph("1.1 years", S["table_cell_c"]),
     Paragraph("2%", S["table_cell_c"]), Paragraph("Negligible", S["table_cell_c"]),
     Paragraph("Preferred volatile agent", ParagraphStyle("sevo2", parent=S["table_cell_c"], textColor=DARK_GREEN, fontName="Helvetica-Bold"))],
    [Paragraph("Xenon (Xe)", ParagraphStyle("xe", parent=S["table_cell_c"], textColor=BLUE_DARK, fontName="Helvetica-Bold")),
     Paragraph("~0 (inert)", S["table_cell_c"]), Paragraph("Inert", S["table_cell_c"]),
     Paragraph("~63%", S["table_cell_c"]), Paragraph("None", S["table_cell_c"]),
     Paragraph("Ideal, but costly", ParagraphStyle("xe2", parent=S["table_cell_c"], textColor=BLUE_DARK, fontName="Helvetica-Bold"))],
]
cw = [(PAGE_W - 2*MARGIN)/6] * 6
gwpt = Table(gwp_data, colWidths=cw, repeatRows=1)
gwpt.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), TEAL),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [WHITE, LIGHT_GREY]),
    ("BOX", (0,0), (-1,-1), 0.8, TEAL),
    ("INNERGRID", (0,0), (-1,-1), 0.3, colors.HexColor("#B2EBF2")),
    ("TOPPADDING", (0,0), (-1,-1), 5), ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING", (0,0), (-1,-1), 4), ("RIGHTPADDING", (0,0), (-1,-1), 4),
    ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
    # Highlight desflurane row
    ("BACKGROUND", (0,1), (-1,1), RED_LIGHT),
    # Highlight sevoflurane row
    ("BACKGROUND", (0,4), (-1,4), colors.HexColor("#E8F5E9")),
]))
story.append(gwpt)
story.append(Spacer(1, 0.3*cm))

# Fresh Gas Flow
story.append(sec_bar("  FRESH GAS FLOW (FGF) MANAGEMENT", TEAL))
story.append(Spacer(1, 0.2*cm))
story.append(Paragraph(
    "Fresh gas flow is the single most modifiable factor in volatile agent consumption. Reducing FGF dramatically "
    "decreases agent waste and costs — without changing the anaesthetic technique.",
    S["body"]
))

fgf_data = [
    [Paragraph("FGF Technique", S["table_hdr"]), Paragraph("Flow Rate", S["table_hdr"]),
     Paragraph("Agent Savings", S["table_hdr"]), Paragraph("Notes", S["table_hdr"])],
    [Paragraph("High-flow (traditional)", S["table_cell_c"]), Paragraph(">2 L/min", S["table_cell_c"]),
     Paragraph("None", ParagraphStyle("no", parent=S["table_cell_c"], textColor=RED_DARK)),
     Paragraph("Avoids rebreathing; no longer recommended routinely", S["table_cell"])],
    [Paragraph("Low-flow", ParagraphStyle("lf", parent=S["table_cell_c"], textColor=MID_GREEN, fontName="Helvetica-Bold")),
     Paragraph("0.5–1 L/min", S["table_cell_c"]),
     Paragraph("~50–70%", ParagraphStyle("s1", parent=S["table_cell_c"], textColor=MID_GREEN, fontName="Helvetica-Bold")),
     Paragraph("Recommended by WFSA, AoA, CAS, DGAI", S["table_cell"])],
    [Paragraph("Minimal-flow", ParagraphStyle("mf", parent=S["table_cell_c"], textColor=DARK_GREEN, fontName="Helvetica-Bold")),
     Paragraph("0.25–0.5 L/min", S["table_cell_c"]),
     Paragraph("~80–85%", ParagraphStyle("s2", parent=S["table_cell_c"], textColor=DARK_GREEN, fontName="Helvetica-Bold")),
     Paragraph("Requires capnography + gas monitoring; highest savings", S["table_cell"])],
    [Paragraph("Closed-circuit", S["table_cell_c"]), Paragraph("<0.25 L/min", S["table_cell_c"]),
     Paragraph("~95%", ParagraphStyle("s3", parent=S["table_cell_c"], textColor=DARK_GREEN, fontName="Helvetica-Bold")),
     Paragraph("Requires full gas monitoring; specialist setting", S["table_cell"])],
]
fgft = Table(fgf_data, colWidths=[3.8*cm, 3*cm, 3*cm, PAGE_W - 2*MARGIN - 9.8*cm])
fgft.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), TEAL),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [WHITE, colors.HexColor("#E0F2F1")]),
    ("BOX", (0,0), (-1,-1), 0.8, TEAL),
    ("INNERGRID", (0,0), (-1,-1), 0.3, colors.HexColor("#B2DFDB")),
    ("TOPPADDING", (0,0), (-1,-1), 5), ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING", (0,0), (-1,-1), 5), ("RIGHTPADDING", (0,0), (-1,-1), 5),
    ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
]))
story.append(fgft)

story.append(PageBreak())

# ════════════════════════════════════════════════════════════════
# PAGE 3  –  THE 6Rs + TIVA + REGIONAL + N2O
# ════════════════════════════════════════════════════════════════
story.append(sec_bar("  THE 6Rs FRAMEWORK (WFSA)", AMBER))
story.append(Spacer(1, 0.2*cm))
story.append(Paragraph(
    "The WFSA adapted the sustainability framework of the '6Rs' for anaesthetic practice. "
    "Each 'R' represents a layer of action, from individual clinician behaviour to systemic change.",
    S["body"]
))
story.append(Spacer(1, 0.15*cm))

rs_data = [
    [Paragraph("The 6R", S["table_hdr"]), Paragraph("Anaesthetic Application", S["table_hdr"]),
     Paragraph("Example Actions", S["table_hdr"])],
    [Paragraph("1. REFUSE", ParagraphStyle("r1", parent=S["table_cell_c"], textColor=RED_DARK, fontName="Helvetica-Bold")),
     Paragraph("Decline high-GWP agents when alternatives exist", S["table_cell"]),
     Paragraph("Refuse desflurane use; decline unnecessary N₂O pipelines", S["table_cell"])],
    [Paragraph("2. REDUCE", ParagraphStyle("r2", parent=S["table_cell_c"], textColor=AMBER, fontName="Helvetica-Bold")),
     Paragraph("Minimise agent consumption and waste generation", S["table_cell"]),
     Paragraph("Low/minimal FGF; shorter surgical times; targeted drug dosing", S["table_cell"])],
    [Paragraph("3. REUSE", ParagraphStyle("r3", parent=S["table_cell_c"], textColor=MID_GREEN, fontName="Helvetica-Bold")),
     Paragraph("Re-process safe, reusable equipment", S["table_cell"]),
     Paragraph("Reusable LMAs, laryngoscopes, breathing circuits; washable drapes", S["table_cell"])],
    [Paragraph("4. RECYCLE", ParagraphStyle("r4", parent=S["table_cell_c"], textColor=TEAL, fontName="Helvetica-Bold")),
     Paragraph("Correct waste stream sorting and agent capture", S["table_cell"]),
     Paragraph("Anaesthetic gas capture canisters (e.g., SageTech); segregate sharps/hazardous waste", S["table_cell"])],
    [Paragraph("5. RETHINK", ParagraphStyle("r5", parent=S["table_cell_c"], textColor=BLUE_DARK, fontName="Helvetica-Bold")),
     Paragraph("Reassess established practices with environmental lens", S["table_cell"]),
     Paragraph("Prefer TIVA or regional blocks; ambulatory-first pathways; telemedicine pre-assessment", S["table_cell"])],
    [Paragraph("6. RESEARCH", ParagraphStyle("r6", parent=S["table_cell_c"], textColor=PURPLE, fontName="Helvetica-Bold")),
     Paragraph("Generate evidence to guide sustainable practice", S["table_cell"]),
     Paragraph("Carbon footprint audits; LCA studies; efficacy of gas capture devices", S["table_cell"])],
]
cw_rs = [2.5*cm, 5.5*cm, PAGE_W - 2*MARGIN - 8*cm]
rst = Table(rs_data, colWidths=cw_rs, repeatRows=1)
rst.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), AMBER),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [AMBER_LIGHT, WHITE]),
    ("BOX", (0,0), (-1,-1), 0.8, AMBER),
    ("INNERGRID", (0,0), (-1,-1), 0.3, colors.HexColor("#FFCC80")),
    ("TOPPADDING", (0,0), (-1,-1), 5), ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING", (0,0), (-1,-1), 6), ("RIGHTPADDING", (0,0), (-1,-1), 6),
    ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
]))
story.append(rst)
story.append(Spacer(1, 0.3*cm))

# TIVA and Regional
story.append(sec_bar("  TIVA & REGIONAL ANAESTHESIA AS GREEN ALTERNATIVES", BLUE_DARK))
story.append(Spacer(1, 0.2*cm))

two_col = Table([
    [info_box(
        "Total IV Anaesthesia (TIVA)",
        [
            "TIVA using propofol + remifentanil/alfentanil eliminates volatile agent "
            "emissions entirely at the point of delivery.",
            "Propofol is water-soluble and metabolised hepatically — its environmental "
            "persistence is far lower than fluorinated volatiles.",
            "TIVA is endorsed by WFSA, AoA, CAS as a primary green strategy.",
            "Limitations: propofol vials contain lipid emulsion (disposal concerns); "
            "higher direct drug cost; awareness risk if pump failure.",
            "Target-Controlled Infusion (TCI) improves precision and reduces drug waste.",
            "TIVA carbon footprint is estimated ~10–20× lower than desflurane-based GA.",
        ],
        title_bg=BLUE_DARK, box_bg=BLUE_LIGHT
    ),
    info_box(
        "Regional / Neuraxial Anaesthesia",
        [
            "Avoids volatile agents entirely; ideal for orthopaedic, obstetric, "
            "urological, and peripheral surgical procedures.",
            "Spinal, epidural, peripheral nerve blocks (ultrasound-guided) — all "
            "reduce or eliminate GA requirement.",
            "Combines well with sedation using low-impact agents (e.g., dexmedetomidine).",
            "Additional benefits: better PONV profile, reduced opioid use, "
            "faster recovery and earlier discharge → further reduces hospital resource use.",
            "Opioid-sparing effect also reduces pharmaceutical waste and patient harm.",
        ],
        title_bg=PURPLE, box_bg=PURPLE_LIGHT
    )]
], colWidths=[(PAGE_W - 2*MARGIN)/2 - 0.2*cm, (PAGE_W - 2*MARGIN)/2 - 0.2*cm])
two_col.setStyle(TableStyle([
    ("TOPPADDING", (0,0), (-1,-1), 0),
    ("BOTTOMPADDING", (0,0), (-1,-1), 0),
    ("LEFTPADDING", (0,0), (-1,-1), 0),
    ("RIGHTPADDING", (0,0), (-1,-1), 4),
    ("VALIGN", (0,0), (-1,-1), "TOP"),
]))
story.append(two_col)

story.append(PageBreak())

# ════════════════════════════════════════════════════════════════
# PAGE 4  –  WASTE MGMT, EQUIPMENT, ENERGY, N2O PIPELINE
# ════════════════════════════════════════════════════════════════
story.append(sec_bar("  WASTE MANAGEMENT IN THE OPERATING ROOM", MID_GREEN))
story.append(Spacer(1, 0.2*cm))
story.append(Paragraph(
    "The OR generates enormous volumes of waste. A single surgical case can produce 4–20 kg of waste. "
    "Proper segregation is mandatory — misclassified waste significantly inflates incineration costs and emissions.",
    S["body"]
))
story.append(Spacer(1, 0.15*cm))

waste_data = [
    [Paragraph("Waste Category", S["table_hdr"]), Paragraph("Examples", S["table_hdr"]),
     Paragraph("Correct Disposal", S["table_hdr"])],
    [Paragraph("Infectious / Clinical", ParagraphStyle("wc1", parent=S["table_cell_c"], textColor=RED_DARK)),
     Paragraph("Blood-soaked drapes, sharps, body fluids", S["table_cell"]),
     Paragraph("Yellow bags → high-temp incineration or autoclave", S["table_cell"])],
    [Paragraph("Non-infectious general", S["table_cell_c"]),
     Paragraph("Outer packaging, paper wrappers, unopened unused supplies", S["table_cell"]),
     Paragraph("Black/clear bags → general landfill or recycle where possible", S["table_cell"])],
    [Paragraph("Pharmaceutical", ParagraphStyle("wc3", parent=S["table_cell_c"], textColor=AMBER)),
     Paragraph("Unused drug vials, propofol residues, volatile agent canisters", S["table_cell"]),
     Paragraph("Segregated pharmaceutical waste bins — NOT drain disposal", S["table_cell"])],
    [Paragraph("Anaesthetic Gas", ParagraphStyle("wc4", parent=S["table_cell_c"], textColor=PURPLE)),
     Paragraph("Exhaled volatiles, waste N₂O from machines", S["table_cell"]),
     Paragraph("AGSS (scavenging) systems; capture canisters for post-machine venting", S["table_cell"])],
    [Paragraph("Recyclable plastics", ParagraphStyle("wc5", parent=S["table_cell_c"], textColor=DARK_GREEN)),
     Paragraph("Uncontaminated syringes, packaging, LMA packaging", S["table_cell"]),
     Paragraph("Clean recycling stream; remove clinical contact items first", S["table_cell"])],
]
cw_w = [3.2*cm, 6*cm, PAGE_W - 2*MARGIN - 9.2*cm]
wt = Table(waste_data, colWidths=cw_w, repeatRows=1)
wt.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), MID_GREEN),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [WHITE, LIGHT_GREY]),
    ("BOX", (0,0), (-1,-1), 0.8, MID_GREEN),
    ("INNERGRID", (0,0), (-1,-1), 0.3, colors.HexColor("#C8E6C9")),
    ("TOPPADDING", (0,0), (-1,-1), 5), ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING", (0,0), (-1,-1), 5), ("RIGHTPADDING", (0,0), (-1,-1), 5),
    ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
]))
story.append(wt)
story.append(Spacer(1, 0.3*cm))

# Equipment + Energy
two_eq = Table([[
    info_box(
        "Equipment: Single-Use vs. Reusable",
        [
            "Life Cycle Assessment (LCA) studies are essential — single-use is NOT "
            "automatically greener than reusable.",
            "Reusable LMAs, laryngoscopes, and breathing circuits have a substantially "
            "lower carbon footprint over their useful life.",
            "Key caveat: reprocessing requires energy and water — facility must have "
            "efficient sterilisation systems.",
            "Packaging waste from single-use items is a major unaddressed contributor.",
            "Recommendation: audit each item using LCA methodology before switching.",
        ],
        title_bg=GOLD, box_bg=colors.HexColor("#FFFDE7")
    ),
    info_box(
        "Energy & N₂O Pipeline Decommissioning",
        [
            "Operating rooms consume 3–6× more energy per m² than any other hospital area.",
            "N₂O piped systems leak continuously — even when not in clinical use.",
            "Studies show pipeline losses of 10–50% of N₂O supplied.",
            "Decommissioning centralised N₂O pipelines and switching to cylinder-on-demand "
            "is recommended by multiple guidelines (UK HAACC, AoA).",
            "Energy: smart HVAC controls, LED lighting, and anaesthesia machine standby "
            "modes can reduce OR energy use by 20–30%.",
        ],
        title_bg=RED_DARK, box_bg=RED_LIGHT
    )
]], colWidths=[(PAGE_W - 2*MARGIN)/2 - 0.2*cm, (PAGE_W - 2*MARGIN)/2 - 0.2*cm])
two_eq.setStyle(TableStyle([
    ("TOPPADDING", (0,0), (-1,-1), 0),
    ("BOTTOMPADDING", (0,0), (-1,-1), 0),
    ("LEFTPADDING", (0,0), (-1,-1), 0),
    ("RIGHTPADDING", (0,0), (-1,-1), 4),
    ("VALIGN", (0,0), (-1,-1), "TOP"),
]))
story.append(two_eq)

story.append(PageBreak())

# ════════════════════════════════════════════════════════════════
# PAGE 5  –  GUIDELINES, IMPLEMENTATION, FUTURE DIRECTIONS
# ════════════════════════════════════════════════════════════════
story.append(sec_bar("  INTERNATIONAL GUIDELINES SNAPSHOT", PURPLE))
story.append(Spacer(1, 0.2*cm))

gl_data = [
    [Paragraph("Organisation", S["table_hdr"]), Paragraph("Key Recommendations", S["table_hdr"])],
    [Paragraph("WFSA (Global, 2022–23)", ParagraphStyle("gl1", parent=S["table_cell"], textColor=PURPLE, fontName="Helvetica-Bold")),
     Paragraph("6Rs framework; reduce volatile use; low-flow FGF; carbon footprint tools; education mandate; global equity.", S["table_cell"])],
    [Paragraph("AoA (UK, 2020)", ParagraphStyle("gl2", parent=S["table_cell"], textColor=BLUE_DARK, fontName="Helvetica-Bold")),
     Paragraph("5R approach; avoid desflurane and N₂O; use low-flow; promote TIVA and regional; reusable equipment.", S["table_cell"])],
    [Paragraph("ASA (USA, 2023)", ParagraphStyle("gl3", parent=S["table_cell"], textColor=RED_DARK, fontName="Helvetica-Bold")),
     Paragraph("Greening the OR checklist; eliminate desflurane; waste stream management; carbon footprint reporting; LCA for equipment.", S["table_cell"])],
    [Paragraph("CAS (Canada, 2023)", ParagraphStyle("gl4", parent=S["table_cell"], textColor=TEAL, fontName="Helvetica-Bold")),
     Paragraph("Lowest-GWP volatile agents; FGF <1 L/min; eliminate/minimise desflurane and N₂O; TIVA/regional preferred; recycling systems.", S["table_cell"])],
    [Paragraph("DGAI/BDA (Germany, 2020)", ParagraphStyle("gl5", parent=S["table_cell"], textColor=MID_GREEN, fontName="Helvetica-Bold")),
     Paragraph("Minimal-flow anaesthesia; avoid desflurane/N₂O unless clinically necessary; biodegradable material audit.", S["table_cell"])],
    [Paragraph("Practice Greenhealth (USA, 2024)", ParagraphStyle("gl6", parent=S["table_cell"], textColor=GOLD, fontName="Helvetica-Bold")),
     Paragraph("Eliminate desflurane and N₂O; retrofit equipment with waste gas trapping/destruction technology; clinician education.", S["table_cell"])],
]
glt = Table(gl_data, colWidths=[3.8*cm, PAGE_W - 2*MARGIN - 3.8*cm], repeatRows=1)
glt.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), PURPLE),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [PURPLE_LIGHT, WHITE]),
    ("BOX", (0,0), (-1,-1), 0.8, PURPLE),
    ("INNERGRID", (0,0), (-1,-1), 0.3, colors.HexColor("#CE93D8")),
    ("TOPPADDING", (0,0), (-1,-1), 5), ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING", (0,0), (-1,-1), 6), ("RIGHTPADDING", (0,0), (-1,-1), 6),
    ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
]))
story.append(glt)
story.append(Spacer(1, 0.3*cm))

# Implementation Checklist
story.append(sec_bar("  PRACTICAL IMPLEMENTATION CHECKLIST FOR CLINICIANS", DARK_GREEN))
story.append(Spacer(1, 0.2*cm))

checklist = [
    ("Pre-operatively", [
        "Consider regional/neuraxial anaesthesia as primary technique — discuss with surgeon.",
        "Use telemedicine/virtual pre-assessment to reduce patient and staff travel.",
        "Order only what you need — avoid opening unnecessary drug vials or equipment packs.",
        "Ensure anaesthetic machine serviced; check for gas leaks at start of list.",
    ], DARK_GREEN, colors.HexColor("#E8F5E9")),
    ("Intra-operatively", [
        "Select sevoflurane over isoflurane/desflurane when volatile GA is necessary.",
        "Target FGF ≤1 L/min after washout phase (first 5–10 min); use minimal-flow where monitored.",
        "Use TIVA (propofol-TCI + remifentanil) as default for procedures >30 min.",
        "Avoid routine N₂O; only use when clinically indicated.",
        "Turn off volatile agent vaporiser when not in use; turn off N₂O valve at machine end.",
    ], TEAL, CYAN_LIGHT),
    ("Post-operatively / End-of-list", [
        "Flush circle system with O₂ at end of list to clear residual volatile.",
        "Document waste streams correctly — do not mix regulated medical waste with general waste.",
        "Return unused, unopened medications to pharmacy where policy allows.",
        "Power down anaesthetic machine completely; use standby mode for multi-list days.",
    ], BLUE_DARK, BLUE_LIGHT),
    ("Systemic / Departmental", [
        "Advocate for desflurane phase-out and N₂O pipeline decommissioning.",
        "Establish anaesthetic gas capture systems (SageTech or equivalent).",
        "Conduct annual carbon footprint audits of the anaesthesia department.",
        "Educate trainees and colleagues — green literacy is now a professional competency.",
    ], PURPLE, PURPLE_LIGHT),
]

for phase, items, hdr_bg, row_bg in checklist:
    phase_data = [[Paragraph(phase, S["table_hdr"])]]
    for item in items:
        phase_data.append([Paragraph(f"✔  {item}", S["box_body"])])
    pt = Table(phase_data, colWidths=[PAGE_W - 2*MARGIN])
    pt.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,0), hdr_bg),
        ("BACKGROUND", (0,1), (-1,-1), row_bg),
        ("BOX", (0,0), (-1,-1), 0.6, hdr_bg),
        ("INNERGRID", (0,0), (-1,-1), 0.2, hdr_bg),
        ("TOPPADDING", (0,0), (-1,-1), 4), ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING", (0,0), (-1,-1), 8), ("RIGHTPADDING", (0,0), (-1,-1), 8),
    ]))
    story.append(pt)
    story.append(Spacer(1, 0.15*cm))

story.append(Spacer(1, 0.2*cm))

# Future Directions
story.append(info_box(
    "  FUTURE DIRECTIONS & EMERGING DEVELOPMENTS",
    [
        "Gas Capture Technology: Devices like SageTech Medical's Blue-Zone recycle exhaled volatile agents — "
        "potentially reclaiming 90%+ of agent for re-manufacturing.",
        "Xenon Anaesthesia: Theoretically zero GWP; ongoing work on economical closed-circuit recycling systems "
        "could make it viable at scale.",
        "AI-Assisted Dosing: Machine learning models to optimise drug delivery and FGF in real time.",
        "Carbon Accounting Tools: Integrated anaesthesia machine software that logs real-time GHG emissions per case.",
        "Green Surgical Pathways: Bundled programs combining regional anaesthesia, enhanced recovery, and day-case "
        "surgery to minimise the entire perioperative footprint.",
        "Policy & Regulation: EU and UK regulatory bodies moving towards mandatory GHG reporting for healthcare "
        "systems; desflurane already banned/restricted in several European countries.",
    ],
    title_bg=DARK_GREEN, box_bg=colors.HexColor("#F1F8E9")
))

story.append(Spacer(1, 0.25*cm))
story.append(HRFlowable(width="100%", thickness=0.5, color=DARK_GREEN))
story.append(Spacer(1, 0.1*cm))
story.append(Paragraph(
    "Sources: WFSA Global Consensus Statement (Anaesthesia, 2022) · AoA Guide to Green Anaesthesia (2020) · "
    "ASA Greening the OR (2023) · CAS Guidelines (2023) · DGAI/BDA Position Paper (2020) · "
    "Best Practice & Research Clinical Anaesthesiology (2025) · GE HealthCare Clinical View",
    S["footer"]
))

# ── Build ──────────────────────────────────────────────────────
doc.build(story)
print("PDF created successfully.")

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import cm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, HRFlowable, PageBreak
)
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY

# ── Color Palette ──────────────────────────────────────────────
DARK_GREEN   = colors.HexColor("#1B5E20")
MID_GREEN    = colors.HexColor("#2E7D32")
LIGHT_GREEN  = colors.HexColor("#A5D6A7")
TEAL         = colors.HexColor("#00695C")
CYAN_LIGHT   = colors.HexColor("#E0F7FA")
AMBER        = colors.HexColor("#E65100")
AMBER_LIGHT  = colors.HexColor("#FFF3E0")
BLUE_DARK    = colors.HexColor("#0D47A1")
BLUE_LIGHT   = colors.HexColor("#E3F2FD")
PURPLE       = colors.HexColor("#4A148C")
PURPLE_LIGHT = colors.HexColor("#F3E5F5")
RED_DARK     = colors.HexColor("#B71C1C")
RED_LIGHT    = colors.HexColor("#FFEBEE")
GOLD         = colors.HexColor("#F57F17")
WHITE        = colors.white
NEAR_BLACK   = colors.HexColor("#1A1A1A")
LIGHT_GREY   = colors.HexColor("#F5F5F5")
DARK_GREY    = colors.HexColor("#424242")

PAGE_W, PAGE_H = A4
MARGIN = 1.8 * cm
TW = PAGE_W - 2 * MARGIN   # usable text width

doc = SimpleDocTemplate(
    "/home/daytona/workspace/green-anesthesia/Green_Anesthesia_Notes.pdf",
    pagesize=A4,
    leftMargin=MARGIN, rightMargin=MARGIN,
    topMargin=MARGIN, bottomMargin=MARGIN,
    title="Green Anesthesia - Comprehensive Notes",
    author="Orris AI"
)

# ── Styles ─────────────────────────────────────────────────────
base = getSampleStyleSheet()

def S(name, parent="Normal", **kw):
    return ParagraphStyle(name, parent=base[parent], **kw)

STYLES = {
    "cover_title": S("cover_title", "Title",
        fontSize=26, textColor=WHITE, alignment=TA_CENTER, leading=32, spaceAfter=6),
    "cover_sub":   S("cover_sub",
        fontSize=12, textColor=LIGHT_GREEN, alignment=TA_CENTER, leading=17, spaceAfter=4),
    "cover_tag":   S("cover_tag",
        fontSize=9.5, textColor=WHITE, alignment=TA_CENTER, leading=14),
    "sec_hdr":     S("sec_hdr",
        fontSize=12, textColor=WHITE, leading=17, fontName="Helvetica-Bold"),
    "subsec":      S("subsec",
        fontSize=10.5, textColor=DARK_GREEN, leading=15, spaceBefore=7, spaceAfter=3,
        fontName="Helvetica-Bold"),
    "body":        S("body",
        fontSize=9, textColor=NEAR_BLACK, leading=14, spaceAfter=4, alignment=TA_JUSTIFY),
    "th":          S("th",
        fontSize=8.5, textColor=WHITE, fontName="Helvetica-Bold",
        alignment=TA_CENTER, leading=12),
    "td":          S("td",
        fontSize=8.5, textColor=NEAR_BLACK, leading=12, alignment=TA_LEFT),
    "tdc":         S("tdc",
        fontSize=8.5, textColor=NEAR_BLACK, leading=12, alignment=TA_CENTER),
    "box_hdr":     S("box_hdr",
        fontSize=9.5, textColor=WHITE, fontName="Helvetica-Bold",
        alignment=TA_CENTER, leading=14),
    "box_body":    S("box_body",
        fontSize=8.8, textColor=NEAR_BLACK, leading=13, alignment=TA_JUSTIFY),
    "footer":      S("footer",
        fontSize=7, textColor=DARK_GREY, alignment=TA_CENTER),
}
st = STYLES   # shortcut

# ── Helpers ────────────────────────────────────────────────────
def sec_bar(title, bg=MID_GREEN):
    t = Table([[Paragraph(title, st["sec_hdr"])]], colWidths=[TW])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), bg),
        ("TOPPADDING",    (0,0), (-1,-1), 6),
        ("BOTTOMPADDING", (0,0), (-1,-1), 6),
        ("LEFTPADDING",   (0,0), (-1,-1), 10),
        ("RIGHTPADDING",  (0,0), (-1,-1), 10),
    ]))
    return t

def info_box(title, items, hdr_bg=TEAL, body_bg=CYAN_LIGHT):
    rows = [[Paragraph(title, st["box_hdr"])]]
    for item in items:
        rows.append([Paragraph(item, st["box_body"])])
    t = Table(rows, colWidths=[TW])
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (0,0),   hdr_bg),
        ("BACKGROUND",    (0,1), (-1,-1), body_bg),
        ("BOX",           (0,0), (-1,-1), 0.8, hdr_bg),
        ("INNERGRID",     (0,0), (-1,-1), 0.3, colors.HexColor("#B2DFDB")),
        ("TOPPADDING",    (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 8),
        ("RIGHTPADDING",  (0,0), (-1,-1), 8),
    ]))
    return t

# helper: bold-coloured cell style
def bcs(name, col):
    return ParagraphStyle(name, parent=base["Normal"],
        fontSize=8.5, textColor=col, fontName="Helvetica-Bold",
        leading=12, alignment=TA_CENTER)

def bcsl(name, col):   # left-aligned bold colour
    return ParagraphStyle(name, parent=base["Normal"],
        fontSize=8.5, textColor=col, fontName="Helvetica-Bold", leading=12)

# ── Story ──────────────────────────────────────────────────────
story = []

# ══════════════════════════════════════════════
# PAGE 1  -  COVER + INTRO
# ══════════════════════════════════════════════
cover = Table(
    [[Paragraph("GREEN ANESTHESIA", st["cover_title"])],
     [Paragraph("Environmentally Sustainable Anaesthesia Practice", st["cover_sub"])],
     [Spacer(1, 0.3*cm)],
     [Paragraph("A Comprehensive Reference for Clinicians", st["cover_tag"])],
     [Spacer(1, 0.15*cm)],
     [Paragraph("June 2026  |  Orris AI Notes", st["cover_tag"])],
    ], colWidths=[TW])
cover.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,-1), DARK_GREEN),
    ("TOPPADDING",    (0,0), (-1,-1), 16),
    ("BOTTOMPADDING", (0,0), (-1,-1), 16),
    ("LEFTPADDING",   (0,0), (-1,-1), 14),
    ("RIGHTPADDING",  (0,0), (-1,-1), 14),
]))
story += [cover, Spacer(1, 0.4*cm)]

story.append(Paragraph(
    "Green Anesthesia refers to clinical practices, policy frameworks, and cultural shifts in anesthesiology "
    "aimed at reducing the environmental footprint of perioperative care - without compromising patient safety. "
    "Healthcare globally accounts for approximately 5% of greenhouse gas (GHG) emissions; anesthesia, "
    "particularly volatile agents, is a disproportionate contributor. This document synthesises key concepts, "
    "current international guidelines, practical strategies, and emerging evidence.", st["body"]))
story.append(Spacer(1, 0.25*cm))

# Key Stats box
story.append(info_box(
    "  WHY IT MATTERS - Key Statistics",
    [
        "* Healthcare contributes approximately 5% of global GHG emissions (comparable to aviation).",
        "* Inhalational anaesthetics alone account for approximately 3% of NHS healthcare emissions (UK data).",
        "* Perioperative services generate approximately 30% of hospital solid waste and most of hospital carbon footprint.",
        "* Desflurane has a Global Warming Potential (GWP) about 2,500 times that of CO2; sevoflurane about 130x; isoflurane about 510x.",
        "* Nitrous oxide (N2O) has an atmospheric lifetime of 123 years and is a potent ozone-depleting substance.",
        "* The WFSA 2022 Global Consensus Statement calls action on green anesthesia a global imperative.",
    ],
    hdr_bg=TEAL, body_bg=CYAN_LIGHT
))
story.append(Spacer(1, 0.25*cm))

# Three Pillars
story.append(Paragraph("Three Foundational Pillars  (WFSA 2022)", st["subsec"]))
pillars = [
    [Paragraph("Pillar", st["th"]),
     Paragraph("Core Principle", st["th"])],
    [Paragraph("Patient Safety First", bcs("p1", DARK_GREEN)),
     Paragraph("Sustainable practices must NEVER compromise patient safety or clinical outcomes.", st["td"])],
    [Paragraph("Global Equity", bcs("p2", BLUE_DARK)),
     Paragraph("High-, middle- and low-income countries should support one another; green anesthesia is not a privilege.", st["td"])],
    [Paragraph("Institutional Mandate", bcs("p3", AMBER)),
     Paragraph("Healthcare systems must be mandated and monitored to reduce their contribution to global warming.", st["td"])],
]
pt = Table(pillars, colWidths=[4*cm, TW - 4*cm])
pt.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), MID_GREEN),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [LIGHT_GREY, BLUE_LIGHT]),
    ("BOX",           (0,0), (-1,-1), 0.8, MID_GREEN),
    ("INNERGRID",     (0,0), (-1,-1), 0.4, colors.HexColor("#C8E6C9")),
    ("TOPPADDING",    (0,0), (-1,-1), 6),
    ("BOTTOMPADDING", (0,0), (-1,-1), 6),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
    ("RIGHTPADDING",  (0,0), (-1,-1), 8),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
]))
story.append(pt)
story.append(PageBreak())

# ══════════════════════════════════════════════
# PAGE 2  -  VOLATILE AGENTS + FGF
# ══════════════════════════════════════════════
story.append(sec_bar("  VOLATILE ANAESTHETIC AGENTS AND ENVIRONMENTAL IMPACT", DARK_GREEN))
story.append(Spacer(1, 0.2*cm))
story.append(Paragraph(
    "Volatile halogenated anaesthetics are potent greenhouse gases. Once exhaled and scavenged, they are typically "
    "vented to the atmosphere. Their environmental impact depends on (a) Global Warming Potential (GWP), "
    "(b) atmospheric lifetime, and (c) the clinical dose required (MAC).", st["body"]))
story.append(Spacer(1, 0.15*cm))

story.append(Paragraph("Comparative Environmental Profile of Volatile Agents", st["subsec"]))
cw6 = [TW/6]*6
gwp = [
    [Paragraph("Agent", st["th"]),
     Paragraph("GWP (100-yr)", st["th"]),
     Paragraph("Atm. Lifetime", st["th"]),
     Paragraph("MAC (%)", st["th"]),
     Paragraph("Ozone Depletion", st["th"]),
     Paragraph("Recommendation", st["th"])],
    [Paragraph("Desflurane",    bcs("df",  RED_DARK)),
     Paragraph("~2,500",  st["tdc"]),
     Paragraph("14 years",st["tdc"]),
     Paragraph("6-8%",    st["tdc"]),
     Paragraph("Negligible",st["tdc"]),
     Paragraph("AVOID / Discontinue", bcs("df2", RED_DARK))],
    [Paragraph("Nitrous Oxide (N2O)", bcs("n2o", AMBER)),
     Paragraph("~265",    st["tdc"]),
     Paragraph("123 years",st["tdc"]),
     Paragraph("~100%",   st["tdc"]),
     Paragraph("YES - significant", ParagraphStyle("oz", parent=base["Normal"],
        fontSize=8.5, textColor=RED_DARK, leading=12, alignment=TA_CENTER)),
     Paragraph("Minimize / Avoid",   bcs("n2o2", AMBER))],
    [Paragraph("Isoflurane",    st["tdc"]),
     Paragraph("~510",    st["tdc"]),
     Paragraph("3.2 years",st["tdc"]),
     Paragraph("1.2%",    st["tdc"]),
     Paragraph("Minimal", st["tdc"]),
     Paragraph("Use with low-flow", st["tdc"])],
    [Paragraph("Sevoflurane",   bcs("sv",  MID_GREEN)),
     Paragraph("~130",    st["tdc"]),
     Paragraph("1.1 years",st["tdc"]),
     Paragraph("2%",      st["tdc"]),
     Paragraph("Negligible",st["tdc"]),
     Paragraph("Preferred volatile", bcs("sv2", MID_GREEN))],
    [Paragraph("Xenon (Xe)",    bcs("xe",  BLUE_DARK)),
     Paragraph("~0 (inert)",st["tdc"]),
     Paragraph("Inert",   st["tdc"]),
     Paragraph("~63%",    st["tdc"]),
     Paragraph("None",    st["tdc"]),
     Paragraph("Ideal, but costly", bcs("xe2", BLUE_DARK))],
]
gwpt = Table(gwp, colWidths=cw6, repeatRows=1)
gwpt.setStyle(TableStyle([
    ("BACKGROUND",     (0,0), (-1,0), TEAL),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [WHITE, LIGHT_GREY]),
    ("BOX",            (0,0), (-1,-1), 0.8, TEAL),
    ("INNERGRID",      (0,0), (-1,-1), 0.3, colors.HexColor("#B2EBF2")),
    ("TOPPADDING",     (0,0), (-1,-1), 5),
    ("BOTTOMPADDING",  (0,0), (-1,-1), 5),
    ("LEFTPADDING",    (0,0), (-1,-1), 3),
    ("RIGHTPADDING",   (0,0), (-1,-1), 3),
    ("VALIGN",         (0,0), (-1,-1), "MIDDLE"),
    ("BACKGROUND",     (0,1), (-1,1), RED_LIGHT),
    ("BACKGROUND",     (0,4), (-1,4), colors.HexColor("#E8F5E9")),
]))
story.append(gwpt)
story.append(Spacer(1, 0.3*cm))

# FGF section
story.append(sec_bar("  FRESH GAS FLOW (FGF) MANAGEMENT", TEAL))
story.append(Spacer(1, 0.2*cm))
story.append(Paragraph(
    "Fresh gas flow is the single most modifiable factor in volatile agent consumption. Reducing FGF dramatically "
    "decreases agent waste and costs - without changing the anaesthetic technique.", st["body"]))
story.append(Spacer(1, 0.1*cm))

cw_fgf = [3.5*cm, 3*cm, 2.8*cm, TW - 9.3*cm]
fgf = [
    [Paragraph("FGF Technique",  st["th"]),
     Paragraph("Flow Rate",      st["th"]),
     Paragraph("Agent Savings",  st["th"]),
     Paragraph("Notes",          st["th"])],
    [Paragraph("High-flow (traditional)", st["tdc"]),
     Paragraph(">2 L/min",  st["tdc"]),
     Paragraph("None",      ParagraphStyle("ns", parent=base["Normal"],
        fontSize=8.5, textColor=RED_DARK, leading=12, alignment=TA_CENTER)),
     Paragraph("Avoids rebreathing; no longer recommended routinely.", st["td"])],
    [Paragraph("Low-flow",  bcs("lf",  MID_GREEN)),
     Paragraph("0.5-1 L/min",  st["tdc"]),
     Paragraph("50-70%",   bcs("s1", MID_GREEN)),
     Paragraph("Recommended by WFSA, AoA, CAS, DGAI.", st["td"])],
    [Paragraph("Minimal-flow", bcs("mf", DARK_GREEN)),
     Paragraph("0.25-0.5 L/min", st["tdc"]),
     Paragraph("80-85%",   bcs("s2", DARK_GREEN)),
     Paragraph("Requires capnography and gas monitoring; highest savings.", st["td"])],
    [Paragraph("Closed-circuit", st["tdc"]),
     Paragraph("<0.25 L/min", st["tdc"]),
     Paragraph("~95%",     bcs("s3", DARK_GREEN)),
     Paragraph("Requires full gas monitoring; specialist setting.", st["td"])],
]
fgft = Table(fgf, colWidths=cw_fgf, repeatRows=1)
fgft.setStyle(TableStyle([
    ("BACKGROUND",     (0,0), (-1,0), TEAL),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [WHITE, colors.HexColor("#E0F2F1")]),
    ("BOX",            (0,0), (-1,-1), 0.8, TEAL),
    ("INNERGRID",      (0,0), (-1,-1), 0.3, colors.HexColor("#B2DFDB")),
    ("TOPPADDING",     (0,0), (-1,-1), 5),
    ("BOTTOMPADDING",  (0,0), (-1,-1), 5),
    ("LEFTPADDING",    (0,0), (-1,-1), 5),
    ("RIGHTPADDING",   (0,0), (-1,-1), 5),
    ("VALIGN",         (0,0), (-1,-1), "MIDDLE"),
]))
story.append(fgft)
story.append(PageBreak())

# ══════════════════════════════════════════════
# PAGE 3  -  6Rs + TIVA + REGIONAL
# ══════════════════════════════════════════════
story.append(sec_bar("  THE 6Rs FRAMEWORK  (WFSA)", AMBER))
story.append(Spacer(1, 0.2*cm))
story.append(Paragraph(
    "The WFSA adapted the sustainability framework of the 6Rs for anaesthetic practice. "
    "Each R represents a layer of action, from individual clinician behaviour to systemic change.", st["body"]))
story.append(Spacer(1, 0.1*cm))

cw_rs = [2.3*cm, 5*cm, TW - 7.3*cm]
rs = [
    [Paragraph("The 6R",              st["th"]),
     Paragraph("Anaesthetic Application", st["th"]),
     Paragraph("Example Actions",     st["th"])],
    [Paragraph("1. REFUSE",  bcs("r1", RED_DARK)),
     Paragraph("Decline high-GWP agents when alternatives exist.", st["td"]),
     Paragraph("Refuse desflurane use; decline unnecessary N2O pipelines.", st["td"])],
    [Paragraph("2. REDUCE",  bcs("r2", AMBER)),
     Paragraph("Minimise agent consumption and waste generation.", st["td"]),
     Paragraph("Low/minimal FGF; shorter surgical times; targeted drug dosing.", st["td"])],
    [Paragraph("3. REUSE",   bcs("r3", MID_GREEN)),
     Paragraph("Re-process safe, reusable equipment.", st["td"]),
     Paragraph("Reusable LMAs, laryngoscopes, breathing circuits; washable drapes.", st["td"])],
    [Paragraph("4. RECYCLE", bcs("r4", TEAL)),
     Paragraph("Correct waste stream sorting and agent capture.", st["td"]),
     Paragraph("Anaesthetic gas capture canisters (e.g., SageTech); segregate sharps and hazardous waste.", st["td"])],
    [Paragraph("5. RETHINK", bcs("r5", BLUE_DARK)),
     Paragraph("Reassess established practices with an environmental lens.", st["td"]),
     Paragraph("Prefer TIVA or regional blocks; ambulatory-first pathways; telemedicine pre-assessment.", st["td"])],
    [Paragraph("6. RESEARCH", bcs("r6", PURPLE)),
     Paragraph("Generate evidence to guide sustainable practice.", st["td"]),
     Paragraph("Carbon footprint audits; LCA studies; efficacy of gas capture devices.", st["td"])],
]
rst = Table(rs, colWidths=cw_rs, repeatRows=1)
rst.setStyle(TableStyle([
    ("BACKGROUND",     (0,0), (-1,0), AMBER),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [AMBER_LIGHT, WHITE]),
    ("BOX",            (0,0), (-1,-1), 0.8, AMBER),
    ("INNERGRID",      (0,0), (-1,-1), 0.3, colors.HexColor("#FFCC80")),
    ("TOPPADDING",     (0,0), (-1,-1), 5),
    ("BOTTOMPADDING",  (0,0), (-1,-1), 5),
    ("LEFTPADDING",    (0,0), (-1,-1), 6),
    ("RIGHTPADDING",   (0,0), (-1,-1), 6),
    ("VALIGN",         (0,0), (-1,-1), "MIDDLE"),
]))
story.append(rst)
story.append(Spacer(1, 0.3*cm))

# TIVA
story.append(sec_bar("  TIVA AND REGIONAL ANAESTHESIA AS GREEN ALTERNATIVES", BLUE_DARK))
story.append(Spacer(1, 0.2*cm))

# TIVA box (full width)
story.append(info_box(
    "Total Intravenous Anaesthesia (TIVA)",
    [
        "TIVA using propofol + remifentanil/alfentanil eliminates volatile agent emissions entirely at the point of delivery.",
        "Propofol is water-soluble and metabolised hepatically - its environmental persistence is far lower than fluorinated volatiles.",
        "TIVA is endorsed by WFSA, AoA, and CAS as a primary green strategy.",
        "Limitations: propofol vials contain lipid emulsion (disposal concerns); higher direct drug cost; awareness risk if pump failure.",
        "Target-Controlled Infusion (TCI) improves precision and reduces drug waste.",
        "TIVA carbon footprint is estimated 10-20 times lower than desflurane-based general anaesthesia.",
    ],
    hdr_bg=BLUE_DARK, body_bg=BLUE_LIGHT
))
story.append(Spacer(1, 0.2*cm))

# Regional box (full width)
story.append(info_box(
    "Regional and Neuraxial Anaesthesia",
    [
        "Avoids volatile agents entirely; ideal for orthopaedic, obstetric, urological, and peripheral surgical procedures.",
        "Spinal, epidural, and peripheral nerve blocks (ultrasound-guided) all reduce or eliminate GA requirement.",
        "Combines well with sedation using low-impact agents such as dexmedetomidine.",
        "Additional benefits: better PONV profile, reduced opioid use, faster recovery and earlier discharge - further reducing hospital resource use.",
        "Opioid-sparing effect also reduces pharmaceutical waste and patient harm.",
    ],
    hdr_bg=PURPLE, body_bg=PURPLE_LIGHT
))
story.append(PageBreak())

# ══════════════════════════════════════════════
# PAGE 4  -  WASTE MANAGEMENT + EQUIPMENT + ENERGY
# ══════════════════════════════════════════════
story.append(sec_bar("  WASTE MANAGEMENT IN THE OPERATING ROOM", MID_GREEN))
story.append(Spacer(1, 0.2*cm))
story.append(Paragraph(
    "The OR generates enormous volumes of waste. A single surgical case can produce 4-20 kg of waste. "
    "Proper segregation is mandatory - misclassified waste significantly inflates incineration costs and emissions.", st["body"]))
story.append(Spacer(1, 0.1*cm))

cw_w = [3*cm, 5.5*cm, TW - 8.5*cm]
waste = [
    [Paragraph("Waste Category",     st["th"]),
     Paragraph("Examples",           st["th"]),
     Paragraph("Correct Disposal",   st["th"])],
    [Paragraph("Infectious / Clinical", bcs("wc1", RED_DARK)),
     Paragraph("Blood-soaked drapes, sharps, body fluids.", st["td"]),
     Paragraph("Yellow bags - high-temp incineration or autoclave.", st["td"])],
    [Paragraph("Non-infectious General", st["tdc"]),
     Paragraph("Outer packaging, paper wrappers, unopened unused supplies.", st["td"]),
     Paragraph("Black/clear bags - general landfill or recycle where possible.", st["td"])],
    [Paragraph("Pharmaceutical",    bcs("wc3", AMBER)),
     Paragraph("Unused drug vials, propofol residues, volatile agent canisters.", st["td"]),
     Paragraph("Segregated pharmaceutical waste bins - NOT drain disposal.", st["td"])],
    [Paragraph("Anaesthetic Gas",   bcs("wc4", PURPLE)),
     Paragraph("Exhaled volatiles, waste N2O from machines.", st["td"]),
     Paragraph("AGSS (scavenging) systems; capture canisters for post-machine venting.", st["td"])],
    [Paragraph("Recyclable Plastics", bcs("wc5", DARK_GREEN)),
     Paragraph("Uncontaminated syringes, packaging, LMA packaging.", st["td"]),
     Paragraph("Clean recycling stream; remove clinical contact items first.", st["td"])],
]
wt = Table(waste, colWidths=cw_w, repeatRows=1)
wt.setStyle(TableStyle([
    ("BACKGROUND",     (0,0), (-1,0), MID_GREEN),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [WHITE, LIGHT_GREY]),
    ("BOX",            (0,0), (-1,-1), 0.8, MID_GREEN),
    ("INNERGRID",      (0,0), (-1,-1), 0.3, colors.HexColor("#C8E6C9")),
    ("TOPPADDING",     (0,0), (-1,-1), 5),
    ("BOTTOMPADDING",  (0,0), (-1,-1), 5),
    ("LEFTPADDING",    (0,0), (-1,-1), 5),
    ("RIGHTPADDING",   (0,0), (-1,-1), 5),
    ("VALIGN",         (0,0), (-1,-1), "MIDDLE"),
]))
story.append(wt)
story.append(Spacer(1, 0.3*cm))

# Equipment box (full width)
story.append(sec_bar("  EQUIPMENT: SINGLE-USE vs. REUSABLE", GOLD))
story.append(Spacer(1, 0.1*cm))
story.append(info_box(
    "Life Cycle Assessment (LCA) Guidance",
    [
        "Life Cycle Assessment studies are essential - single-use is NOT automatically greener than reusable.",
        "Reusable LMAs, laryngoscopes, and breathing circuits have a substantially lower carbon footprint over their useful life.",
        "Key caveat: reprocessing requires energy and water - facility must have efficient sterilisation systems.",
        "Packaging waste from single-use items is a major unaddressed contributor to OR waste volume.",
        "Recommendation: audit each item using LCA methodology before switching between single-use and reusable.",
    ],
    hdr_bg=GOLD, body_bg=colors.HexColor("#FFFDE7")
))
story.append(Spacer(1, 0.25*cm))

# N2O Pipeline and Energy box (full width)
story.append(sec_bar("  N2O PIPELINE DECOMMISSIONING AND OR ENERGY USE", RED_DARK))
story.append(Spacer(1, 0.1*cm))
story.append(info_box(
    "N2O Pipelines and OR Energy - Key Facts",
    [
        "Operating rooms consume 3-6 times more energy per square metre than any other hospital area.",
        "N2O piped systems leak continuously - even when not in clinical use. Studies show pipeline losses of 10-50% of N2O supplied.",
        "Decommissioning centralised N2O pipelines and switching to cylinder-on-demand is recommended by UK HAACC, AoA, and others.",
        "Energy reduction: smart HVAC controls, LED lighting, and anaesthesia machine standby modes can reduce OR energy use by 20-30%.",
        "Turning off the N2O valve at the machine after each list is a simple zero-cost intervention with measurable impact.",
    ],
    hdr_bg=RED_DARK, body_bg=RED_LIGHT
))
story.append(PageBreak())

# ══════════════════════════════════════════════
# PAGE 5  -  GUIDELINES + CHECKLIST + FUTURE
# ══════════════════════════════════════════════
story.append(sec_bar("  INTERNATIONAL GUIDELINES SNAPSHOT", PURPLE))
story.append(Spacer(1, 0.15*cm))

cw_gl = [3.5*cm, TW - 3.5*cm]
gl = [
    [Paragraph("Organisation",      st["th"]),
     Paragraph("Key Recommendations", st["th"])],
    [Paragraph("WFSA\n(Global, 2022-23)", bcsl("gl1", PURPLE)),
     Paragraph("6Rs framework; reduce volatile use; low-flow FGF; carbon footprint tools; education mandate; global equity.", st["td"])],
    [Paragraph("AoA\n(UK, 2020)",   bcsl("gl2", BLUE_DARK)),
     Paragraph("5R approach; avoid desflurane and N2O; use low-flow; promote TIVA and regional; reusable equipment.", st["td"])],
    [Paragraph("ASA\n(USA, 2023)",  bcsl("gl3", RED_DARK)),
     Paragraph("Greening the OR checklist; eliminate desflurane; waste stream management; carbon footprint reporting; LCA for equipment.", st["td"])],
    [Paragraph("CAS\n(Canada, 2023)", bcsl("gl4", TEAL)),
     Paragraph("Lowest-GWP volatile agents; FGF <1 L/min; eliminate/minimise desflurane and N2O; TIVA/regional preferred; recycling systems.", st["td"])],
    [Paragraph("DGAI/BDA\n(Germany, 2020)", bcsl("gl5", MID_GREEN)),
     Paragraph("Minimal-flow anaesthesia; avoid desflurane/N2O unless clinically necessary; biodegradable material audit.", st["td"])],
    [Paragraph("Practice Greenhealth\n(USA, 2024)", bcsl("gl6", GOLD)),
     Paragraph("Eliminate desflurane and N2O; retrofit equipment with waste gas trapping and destruction technology; clinician education.", st["td"])],
]
glt = Table(gl, colWidths=cw_gl, repeatRows=1)
glt.setStyle(TableStyle([
    ("BACKGROUND",     (0,0), (-1,0), PURPLE),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [PURPLE_LIGHT, WHITE]),
    ("BOX",            (0,0), (-1,-1), 0.8, PURPLE),
    ("INNERGRID",      (0,0), (-1,-1), 0.3, colors.HexColor("#CE93D8")),
    ("TOPPADDING",     (0,0), (-1,-1), 5),
    ("BOTTOMPADDING",  (0,0), (-1,-1), 5),
    ("LEFTPADDING",    (0,0), (-1,-1), 6),
    ("RIGHTPADDING",   (0,0), (-1,-1), 6),
    ("VALIGN",         (0,0), (-1,-1), "MIDDLE"),
]))
story.append(glt)
story.append(Spacer(1, 0.25*cm))

# Checklist as a clean single table
story.append(sec_bar("  PRACTICAL IMPLEMENTATION CHECKLIST FOR CLINICIANS", DARK_GREEN))
story.append(Spacer(1, 0.1*cm))

checklist_rows = [
    [Paragraph("Phase", st["th"]), Paragraph("Action Items", st["th"])]
]

phases = [
    ("Pre-Operative",
     ["Consider regional/neuraxial anaesthesia as primary technique - discuss with surgeon.",
      "Use telemedicine or virtual pre-assessment to reduce travel.",
      "Order only what you need - avoid opening unnecessary drug vials or equipment packs.",
      "Ensure anaesthetic machine is serviced; check for gas leaks at start of list."],
     DARK_GREEN),
    ("Intra-Operative",
     ["Select sevoflurane over isoflurane/desflurane when volatile GA is necessary.",
      "Target FGF 1 L/min or less after washout phase (first 5-10 min); use minimal-flow where monitored.",
      "Use TIVA (propofol-TCI + remifentanil) as default for procedures over 30 min.",
      "Avoid routine N2O; only use when clinically indicated.",
      "Turn off volatile agent vaporiser when not in use; close N2O valve at machine end."],
     TEAL),
    ("Post-Operative / End-of-List",
     ["Flush circle system with O2 at end of list to clear residual volatile.",
      "Sort waste streams correctly - do not mix regulated medical waste with general waste.",
      "Return unused, unopened medications to pharmacy where policy allows.",
      "Power down anaesthetic machine completely; use standby mode for multi-list days."],
     BLUE_DARK),
    ("Departmental / Systemic",
     ["Advocate for desflurane phase-out and N2O pipeline decommissioning.",
      "Establish anaesthetic gas capture systems (SageTech or equivalent).",
      "Conduct annual carbon footprint audits of the anaesthesia department.",
      "Educate trainees and colleagues - green literacy is now a professional competency."],
     PURPLE),
]

bg_map = []
row_idx = 1
for phase_name, items, hdr_col in phases:
    bullet_text = "\n".join(f"  + {item}" for item in items)
    combined = Paragraph(
        "<br/>".join(f"  + {item}" for item in items),
        ParagraphStyle(f"chk_{phase_name}", parent=base["Normal"],
            fontSize=8.3, textColor=NEAR_BLACK, leading=13)
    )
    checklist_rows.append([
        Paragraph(phase_name, ParagraphStyle(f"ph_{phase_name}", parent=base["Normal"],
            fontSize=8.5, textColor=WHITE, fontName="Helvetica-Bold",
            leading=13, alignment=TA_CENTER)),
        combined
    ])
    bg_map.append((row_idx, hdr_col))
    row_idx += 1

ck_t = Table(checklist_rows, colWidths=[3*cm, TW - 3*cm])
ck_style = [
    ("BACKGROUND",    (0,0), (-1,0), DARK_GREEN),
    ("BOX",           (0,0), (-1,-1), 0.8, DARK_GREEN),
    ("INNERGRID",     (0,0), (-1,-1), 0.4, colors.HexColor("#A5D6A7")),
    ("TOPPADDING",    (0,0), (-1,-1), 6),
    ("BOTTOMPADDING", (0,0), (-1,-1), 6),
    ("LEFTPADDING",   (0,0), (-1,-1), 7),
    ("RIGHTPADDING",  (0,0), (-1,-1), 7),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
]
for ri, col in bg_map:
    ck_style.append(("BACKGROUND", (0, ri), (0, ri), col))
    ck_style.append(("BACKGROUND", (1, ri), (1, ri), LIGHT_GREY))

ck_t.setStyle(TableStyle(ck_style))
story.append(ck_t)
story.append(Spacer(1, 0.2*cm))

# Future directions (compact, full width)
story.append(info_box(
    "  FUTURE DIRECTIONS AND EMERGING DEVELOPMENTS",
    [
        "Gas Capture Technology: Devices like SageTech Medical's Blue-Zone recycle exhaled volatile agents - potentially reclaiming 90%+ of agent for re-manufacturing.",
        "Xenon Anaesthesia: Theoretically zero GWP; ongoing work on economical closed-circuit recycling systems could make it viable at scale.",
        "AI-Assisted Dosing: Machine learning models to optimise drug delivery and FGF in real time, minimising waste.",
        "Carbon Accounting Tools: Integrated anaesthesia machine software that logs real-time GHG emissions per case.",
        "Green Surgical Pathways: Bundled programs combining regional anaesthesia, enhanced recovery, and day-case surgery.",
        "Policy: EU and UK regulators moving towards mandatory GHG reporting; desflurane already banned/restricted in several European countries.",
    ],
    hdr_bg=DARK_GREEN, body_bg=colors.HexColor("#F1F8E9")
))

story.append(Spacer(1, 0.2*cm))
story.append(HRFlowable(width="100%", thickness=0.5, color=DARK_GREEN))
story.append(Spacer(1, 0.1*cm))
story.append(Paragraph(
    "Sources: WFSA Global Consensus Statement (Anaesthesia, 2022) | AoA Guide to Green Anaesthesia (2020) | "
    "ASA Greening the OR (2023) | CAS Guidelines (2023) | DGAI/BDA Position Paper (2020) | "
    "Best Practice & Research Clinical Anaesthesiology (2025) | GE HealthCare Clinical View",
    st["footer"]
))

# ── Build PDF ──────────────────────────────────────────────────
doc.build(story)
print("PDF created successfully.")