Conventional Fluid Management vs Plethysmographic Variability Index -Based Goal Directed Fluid Management

Exclusion Criteria

• •• Operations which will last for less than 15 minutes. (e.g.: plate and screw adjustment or incomplete terminated surgery)
• •* Patients with cardiac morbidities e.g. history of unstable angina, impaired contractility with ejection fraction \< 40%, wall motional abnormalities or tight valvular lesions detected by echocardiography, previous cardiac operations or cardiac catherization with stent.
• •* Patients with heart block and arrhythmia (atrial fibrillation and frequent ventricular or supraventricular premature beat).
• •* Patient with decompensated respiratory disease (poor functional capacity, generalized wheezes, peripheral O2 saturation \< 90% on room air).
• •* Patients with peripheral vascular disease or long-standing DM affecting PVI readings.
• •* Complicated surgeries (huge spine tumors, intraoperative vascular or neurological complications and prolonged durations more than 5 hours) or surgeries with massive blood loss (4 units of packed RBCs in 1 hour or replacement of 50% of total blood volume within 3 hours )
• •* Pregnancy.