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Acute kidney injury (AKI) is a serious postoperative complication that increases patients' risk for long- and shortterm morbidity and mortality. Risk for developing AKI increases following intraoperative hypotension (IOH). This project aimed to describe the rate of and establish IOH as an independent risk factor for AKI among adults undergoing non-cardiac surgery at a large tertiary care medical center. An observational, retrospective, evidence-based practice project was conducted. Records were extracted for adults undergoing general anesthesia for non-cardiac surgery from 2015 to 2019 with available serum creatinine laboratory results. The primary project outcome was postoperative AKI. Among 4,603 cases, 8.9% experienced postoperative AKI. Cases with IOH (MAPs less than 60 mmHg for at least 10 minutes) compared to cases without IOH had increased risks for AKI (RR 1.48, 95% CI [1.19-1.84], P<.001). In a fully adjusted model, IOH was an independent risk factor for AKI (OR 1.50, 95% CI [1.18-1.92], P=.001). Among cases with serum creatinine laboratory results, the rate of AKI was higher than reported literature rates. IOH was confirmed as an independent risk factor. Quantifying the rate of and risk factors for AKI may precipitate heightened attention to prevention strategies and encourage quality improvement initiatives., Competing Interests: Name: Elizabeth Davison, DNAP, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None Name: Amanda Affleck, DNAP, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None Name: Kenn B. Daratha, PhD Contribution: This author made significant contributions to the conception, synthesis, writing and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None The authors did not discuss off-label use within the article. Disclosure statements are available for viewing upon request., (Copyright © by the American Association of Nurse Anesthetists.)

Volatile anesthetic agents act as greenhouse gases. Low-flow anesthesia techniques (≤1 L/min) are associated with lower costs. Decreasing volatile anesthetic delivery provides safe and effective strategies for anesthesia providers to decrease costs and reduce environmental pollution. This evidence-based project aimed to estimate cost savings and reduction in the environmental release of anesthetic gases, under simulated lower fresh gas flow (FGF) practices. For each surgical case, the exhaled anesthetic gas percent and FGF data were used to calculate the volume of fluid volatile anesthetic. The fluid volatile anesthetic for each case was then estimated using simulated FGFs. Changes in volatile agent cost and environmental release of anesthetic gases were predicted. Sevoflurane was the most commonly used volatile agent. The mean FGF for cases using sevoflurane was 2.5 L/min. The simulated FGF of 1 L/min FGF across all agents predicted a 48% ($50,892) reduction in costs of volatile anesthetics and a 42% (33 metric tons of carbon dioxide equivalent) decrease in carbon emissions. Simulated low-flow anesthesia demonstrated cost savings and environmental conservation. Project findings align with current literature showing that lowering FGFs represents an area of cost containment and an opportunity to lessen the environmental impact of anesthesia., Competing Interests: The authors have declared no financial relationships with any commercial entity related to the content of this article. The authors did not discuss off-label use within the article. Disclosure statements are available for viewing upon request., (Copyright © by the American Association of Nurse Anesthetists.)