The implementation of low-carbon healthcare practices will be significantly enhanced by the role of anesthesia personnel. While there is a lack of data on the specific measures being implemented by anesthesia departments in Austria, we conducted interviews with six experts in sustainability within anesthesia to address this knowledge gap. These experts provided insights on strategies for reducing the CO₂ impact in the operating theatre, the level of interest among anesthetists in sustainability, the role of green teams in hospitals, and future prospects for sustainable anesthesia. While Austria has made progress in reducing the use of Desfluran, waste separation within operating theatres remains a significant issue. Green teams are present in hospitals, but there is a need for the greater inclusion of anesthetists and clinical staff. The topic of sustainability is becoming increasingly important in the field of anesthesia, and the past three years have witnessed a significant push towards reducing CO₂ emissions in hospitals across Austria. The experts identified key steps towards achieving sustainable anesthesia, emphasizing the need for an internal motivation to drive meaningful change. This study highlights the numerous measures that have already been implemented in the pursuit of sustainability in anesthesia and the ongoing efforts towards further improvement.

Patient Blood Management (PBM) is a multidisciplinary strategy to optimise patient outcomes by preserving autologous blood and reducing unnecessary transfusion. Although PBM initiatives exist worldwide, the consistency of national guideline recommendations remains unclear. This review compared international PBM programmes and explored reasons for variation. A systematic review was conducted in accordance with PRISMA guidelines. In March 2024, Medline, Cochrane Library, and Google Scholar were searched for publications from the past 20 years, supplemented by governmental and institutional sources. Guidelines were assessed using the International Centre for Allied Health Evidence checklist. Laws, nationally implemented guidelines, or documents with ministerial involvement were included for a comparative text analysis if they addressed defined PBM elements, were freely accessible, and met quality criteria. The review was registered on PROSPERO and completed in 2025. Forty national and institutional guidelines were analysed. The greatest variability concerned strategies to reduce diagnostic blood loss. In contrast, most other PBM domains showed substantial agreement, particularly regarding restrictive transfusion strategies, most defined by a haemoglobin threshold of 7 g dl^-1 (22 guidelines) or lower (nine guidelines). National standardisation was frequently absent, even in countries with advanced hospital-level PBM programmes. Guidance for acute care and intensive care was usually issued by specialty societies rather than national authorities; prehospital recommendations were scarce. National guidelines on Patient Blood Management remain fragmented, as comprehensive policy frameworks and multidisciplinary coordination are lacking. Greater harmonisation and structured change management are required to support wider global adoption of PBM. CRD420251032664 (PROSPERO).

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.

Introduction: Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality worldwide. While antifibrinolytic agents such as tranexamic acid are effective in treating established postpartum hemorrhage, the benefit of prophylactic tranexamic acid remains debated. The presence and frequency of early postpartum hyperfibrinolysis during routine childbirth have not been thoroughly investigated. Material & Methods: This prospective observational study was registered on ClinicalTrials.gov (NCT05975112) and conducted at the Medical University Hospital Graz between June 2023 and June 2024. Blood samples were collected from 413 women immediately after umbilical cord clamping; 379 were included in the analysis—291 undergoing Caesarean section and 88 vaginal delivery. Hyperfibrinolysis was assessed using thromboelastography and defined as an LY30 value > 8%. Additional coagulation parameters—including fibrinogen, D-dimer, activated partial thromboplastin time, and prothrombin time—were measured. Correlation analyses between viscoelastic and conventional parameters were performed using Pearson’s correlation coefficients. Results: No cases of clinically significant hyperfibrinolysis (LY30 > 8%) were observed. However, 15.5% of women showed elevated LY30 values (>0%). LY30 values were significantly higher in vaginal deliveries compared to Caesarean sections (p = 0.003). A moderate correlation between maximum amplitude (MA) and fibrinogen was observed (r = 0.52), strongest in vaginal deliveries (r = 0.65). Other correlations were weak or negligible. Conclusions: Clinically relevant hyperfibrinolysis was not observed immediately postpartum in women without hemorrhage. These findings are consistent with current guidelines recommending tranexamic acid for therapeutic rather than routine prophylactic use. Viscoelastic testing may be useful for rapid assessment in early-stage bleeding. Further research should explore fibrinolytic activity later in the postpartum period.

Objective: Accurate visual estimation of blood loss is critical for early recognition of obstetric haemorrhage. Despite its widespread use, visual estimation is prone to substantial bias. While professional experience has been shown to influence estimation accuracy, the potential contribution of gender-associated visual perceptual differences remains insufficiently explored . Design: We carried out a prospective observational simulation-based study at a tertiary university medical centre in Graz, Austria Setting/Sample: 50 physicians (28 females/22 males) were recruited from anaesthesiology and obstetrics. Eligibility required at least three months of clinical experience in obstetrics or obstetric anaesthesia. Clinicians with known colour-vision deficiency were excluded. Methods: All participants visually estimated blood loss in four simulated obstetric scenarios. The blood volumes and haemoglobin concentrations were verified by volume measurement and point of care testing. Each scenario was viewed individually under standardized conditions without access to physiological or contextual clinical information. Main Outcome Measures The primary outcome was absolute estimation error (mL) according to gender or professional background of participants. Secondary outcomes included scenario-specific accuracy and the association between self-rated confidence and estimation accuracy. Results: Women outperformed men in low and moderate volume scenarios. Across all scenarios the overall difference median absolute estimation error did not reach statistical significance. Professional background showed a stronger effect than gender: gynaecologists were significantly more accurate than anaesthetists across most scenarios (p < 0.001). Conclusions: Visual blood loss estimation accuracy in obstetric simulations is influenced by both gender and professional background. Gender-related differences appear volume-dependent, whereas professional experience exerts a consistent influence.