A multicenter, interventional, feasibility comparison with historical controls

Inclusion Criteria:

• Signed informed consent
• Age ≥ 18 years
• ASA Physical Status ≥ 2
• Elective noncardiac surgery with expected surgery duration ≥ 3 hours and expected post-operative length of stay of ≥ 3 days
• Planned monitoring with an arterial catheter; Cohort 2: without planned arterial catheter insertion
• General anesthesia with tracheal intubation and positive pressure ventilation

Exclusion Criteria:

• Inability to comply with the study intra-operative hemodynamic management algorithm such as surgeon request for relative hypotension or fluid restriction or avoidance of vasopressors
• Planned vasopressor or inotrope infusion during surgery
• Contraindication to intra-arterial blood pressure monitoring
• Has previously participated in the SMART TRENDS study
• Serum creatine > 2.0 mg/dL (> 175 μmol/L) or CKD stage > 3A
• Scheduled for intracranial or cardiac surgery
• Patient who is known to be pregnant
• Patients on mechanical circulatory support
• Emergency surgery
• Planned beach-chair positioning

Additional Exclusion Criteria for Cohort 2 only:

• Extreme contraction of the smooth muscle in the arteries and arterioles of the lower arm and hand, such as may be present in patients with Raynaud's disease
• Finger or hand deformity that prevents proper placement of finger cuff by visual inspection
• Inability to place Acumen IQ finger cuffs due to subject anatomy, condition, or obstructive paraphernalia (such as false nails)

HemoSphere ClearSight Module and Pressure Controller, and adult Acumen IQ finger cuff