Please select the eligibility criteria that correspond to the clinical trial below.
Title: Individualized Perioperative Hemodynamic Goal-directed Therapy in Major Abdominal Surgery (iPEGASUS-trial) - A Multi-center, Prospective, Randomized Trial
Brief Summary: To evaluate the impact of perioperative, algorithm driven, hemodynamic therapy based on individualized fluid and cardiac output optimization on postoperative moderate and severe complications in patients undergoing major abdominal surgery including visceral, urological, and gynecological operations.

In the proposed study, hemodynamic therapy is tailored individually to each patient, based on individual preload optimization by the functional parameter "pulse pressure variation (PPV)" and based on an individually titrated goal of cardiac index. The proposed study therefore further develops the concept of hemodynamic goal-directed therapy to individually set goals and is designed to assess its impact on morbidity and mortality.


Options:
A: Inclusion Criteria:

* American Society of Anesthesiologists physical class I-III patients over the age of 18 years
* Presenting for elective open repair of abdominal aortic aneurysms.

Exclusion Criteria:

* Weight \>120kg
* Known or suspected valvular aortic insufficiency
* Renal Dysfunction (serum creatinine \>150 μmol/l)
* Pre-existing bowel dysfunction
* Active congestive heart failure
B: Inclusion Criteria:

* age greater than 18 years
* signed informed consent
* listed for deceased donor transplantation.

Exclusion Criteria:

* esophageal surgery or cancer
* esophageal stricture, varices or diverticulum
* upper airway surgery
* coarctation of the aorta
* significant valvular heart disease
* clinically significant cardiac arrhythmias
* patient randomized to other trials with an outcome variable of delayed graft function or early graft function will also be excluded
C: Inclusion Criteria:

* To provide high generalizability and representativeness the high number of patients with laparotomy and major surgical trauma is included into this study. - Therefore, open visceral, urological, and gynecological surgery is covered by this study.
* Expected duration of surgery must be ≥ 120 minutes and requirement of volume therapy needs to be expected ≥ 2 liters.
* Risk for any postoperative complications needs to be ≥10% assessed by the ACS (American College of Surgery)- NSQUIP (National Surgical Quality Improvement Program) risk calculator.

Exclusion Criteria:

* Patients \<18 years,
* laparoscopic approach,
* patients not having sinus rhythm,
* patients having highly impaired left ventricular function (ejection fraction \<30%) or severe aortic valve stenosis (aortic valve area \<1 cm2, mean gradient \>40 mmHg),
* pregnant women,
* emergency surgeries (surgery required within 24 hours),
* primarily vascular surgery,
* patients suffering from septic shock,
* patients having phaeochromocytoma,
* patients suffering from non-cardiac chest pain,
* refusal of consent,
* patients receiving palliative treatment only (likely to die within 6 months) and patients suffering from acute myocardial ischemia (within 30 days before randomization) are excluded from the study.
* Further, in case that clinicians intended to use cardiac output monitoring for clinical reasons patients should also not be included in the study.
D: Inclusion Criteria:

* Elective major abdominal surgery
* Patient physical status ASA 2-4
* General anesthesia with positive pressure ventilation
* High risk surgical patient with a per operative Vigileo® cardiac output monitoring decided a priori.

Exclusion Criteria:

* Pregnant female
* Intraoperative hyperthermic chemotherapy procedure
* Patient physical status ASA more than 4
* Patient with allergy to hydroxyethyl starch
* Cardiac arrhythmia
* ventilation with tidal volume inferior 7mL/Kg

Answer: C