Anaesthesia contributes to greenhouse gas emissions and can play a crucial role in reducing the carbon footprint of the global healthcare sector. The aim of this systematic review is to identify which departmental interventions influence estimated carbon dioxide (CO₂) equivalent emissions of anaesthesia and to quantify their reductions. A systematic literature search was conducted through four major electronic databases (Cochrane Library, Embase, MEDLINE, and PubMed) for studies investigating the changes in CO₂ equivalent emissions per anaesthetic before and after departmental green anaesthesia interventions. Data were extracted by two independent reviewers. The primary outcomes were mean decrease of CO₂ equivalents in kilograms per anaesthetic and total decrease in CO₂ equivalents in tonnes. The mean effect was calculated as percentage change per patient and in total. Of 3987 screened studies, 13 met the criteria for quantitative synthesis and showed low to moderate risk of bias. The following types of departmental sustainability interventions were found: education of staff, decreased use of desflurane and sevoflurane, promotion of TIVA, use of low fresh gas flows, proper waste management, and formation of green teams. The postinterventional total mean decrease of CO₂ equivalents in kilograms per anaesthetic was 68.2% (18.6%) and in total tonnes was 75.2% (16.3%). Our analysis demonstrates the substantial CO₂ reduction potential inherent in sustainable anaesthesia programmes. Currently available literature supports staff education on avoidance of desflurane, reduction of volatile anaesthesia, lower fresh gas flow, increased utilisation of TIVA, and implementation of proper waste management protocols in operating rooms as potentially effective interventions.

Aim of this study: This study seeks to investigate, whether extubation of tracheally intubated patients admitted to intensive care units (ICU) postoperatively either immediately at the day of admission (day 1) or delayed at the first postoperative day (day 2) is associated with differences in outcomes. Materials and methods: We performed a retrospective analysis of data from an Austrian ICU registry. Adult patients admitted between January 1^st, 2012 and December 31^st, 2019 following elective and emergency surgery, who were intubated at the day 1 and were extubated at day 1 or day 2, were included. We performed logistic regression analyses for in-hospital mortality and over-sedation or agitation following extubation. Results: 52 982 patients constituted the main study population. 1 231 (3.3%) patients extubated at day 1 and 958 (5.9%) at day 2 died in hospital, 464 (1.3%) patients extubated at day 1 and 613 (3.8%) at day 2 demonstrated agitation or over-sedation after extubation during ICU stay; OR (95% CI) for in-hospital mortality were OR 1.17 (1.01–1.35, p = 0.031) and OR 2.15 (1.75–2.65, p<0.001) for agitation or over-sedation. Conclusions: We conclude that immediate extubation as soon as deemed feasible by clinicians is associated with favourable outcomes and may thus be considered preferable in tracheally intubated patients admitted to ICU postoperatively.

Cardiac output monitoring is recommended for high-risk surgical patients and critically ill patients with circulatory shock. We performed a systematic review and meta-analysis of clinical studies published since 2010 that compared minimally invasive pulse wave analysis-derived cardiac output or cardiac index measurements with reference measurements by pulmonary artery thermodilution or transpulmonary thermodilution in adult surgical or critically ill patients. In a random-effects meta-analysis, we calculated pooled estimates of the percentage error, mean difference and standard deviation, and 95% limits of agreement separately for studies reporting cardiac output or cardiac index. Subgroup analyses were performed by patient population and test device. We included 92 studies divided into 113 data sets with a total of 3111 patients. For 71 data sets reporting cardiac output, the pooled percentage error (95% confidence interval [95% CI]) was 44.0% (38.2%-49.8%) with a mean difference (standard deviation) of -0.1 (1.3) L min^-1 with 95% limits of agreement of -2.6 to 2.4 L min^-1 (I²=9.8%). For 42 data sets reporting cardiac index, the pooled percentage error was 49.1% (40.6%-57.6%) with a mean difference of -0.1 (0.9) L min^-1 m^-2 with 95% limits of agreement of -1.8 to 1.6 L min^-1 m^-2 (I²=7.9%). The percentage error varied substantially across patient populations and devices. Overall risk of bias was low. The pooled percentage error between minimally invasive pulse wave analysis-derived cardiac output measurements of 44.0% (cardiac output) and 49.1% (cardiac index) in adult surgical or critically ill patients exceeds the 30% threshold for clinically acceptable agreement. However, the percentage error varied depending on the patient population and device used. PROSPERO (CRD420251090806; submitted July 17, 2025).

We present a time‐efficient, clinically integrated lung ultrasound protocol tailored for prehospital use by providers not yet routinely using ultrasound. Specifically designed to support the recognition of pneumothorax and interstitial syndrome, the protocol emphasizes operational feasibility, spectrum‐based diagnostic reasoning, and strict time limitations to avoid delays in definitive care. It includes standardized scanning sequences, documentation, and a governance framework for training, certification, and quality assurance. Developed and implemented in an Austrian ambulance service, it may serve as a scalable model for expanding ultrasound access. A prospective registry supports the evaluation of feasibility, image quality, diagnostic yield, and clinical impact.

Background: Postinduction hypotension in major noncardiac surgery is common and a modifiable risk factor for adverse outcomes. There is an ongoing debate whether preoperative crystalloid fluid administration can reduce the incidence or severity of postinduction hypotension. This study aims to assess whether a preoperative intravenous crystalloid bolus reduces postinduction hypotension in high-risk patients during general anesthesia. Methods: This was a prospective, randomized, single-blind clinical trial conducted at two centers in Austria (Medical University of Graz, Medical University of Vienna). Adult patients 45 yr and older with cardiovascular risk factors undergoing major surgery were enrolled and randomly assigned to receive a preoperative crystalloid bolus within 60 ± 15 min before anesthetic induction, or to receive standard care. The primary outcome was the time-weighted average mean arterial pressure of less than 65 mmHg within the first 20 min after induction or until surgical incision. Results: Of the 504 patients analyzed (247 in the intervention group and 257 in the control group), no statistically significant difference in median time-weighted average of the mean arterial pressure less than 65 mmHg was observed (intervention group, 0.0 mmHg; interquartile range, 0.0 to 0.56; standard of care group, 0.0 mmHg; interquartile range, 0.0 to 0.84; P = 0.368). Conclusions: In this blinded randomized clinical trial, administering a crystalloid fluid bolus within 60 min before surgery did not significantly reduce the time-weighted average of a mean arterial pressure less than 65 mmHg compared to standard care in patients with cardiovascular risk factors undergoing major noncardiac surgery. This study suggests that administering crystalloids before surgery does not prevent postinduction hypotension.