Inclusion Criteria:  Age ≥ 45 American Society of Anesthesiologists physical status class (ASA) II-IV scheduled for elective major surgery under general anesthesia surgery expected to last ≥ 120 minutes  Exclusion Criteria:  emergency surgery patients having liver or kidney transplantation laparoscopic surgery pregnancy status of post transplantation of kidney, liver, heart, or lung sepsis (according to current Sepsis-3 definition) impossibility of preoperative automated blood pressure monitoring MAP differences between the right and the left arm of more than 20 mmHg surgery that requires controlled hypotension