Respiratory and Hemodynamic Targets During General Anesthesia

Eligible patients will be defined as those meeting all inclusion criteria and none of the exclusion criteria 1 to 4.

Adherence will be defined as follows:

The allocated positive end expiratory pressure (± 1 cm H2O), tidal volume (± 1 ml/kg), and FiO2 (± 5%) is used in a minimum of 90% of the randomized patients for the duration of the surgery.

Vasopressors/inotropes are only initiated and continued if the blood pressure declines below the allocated target in at least 60% of the patients and at least 60% of time during general anesthesia, i.e., 60% of the registered blood pressures should be within +/- 10 mmHg of the target when vasopressor/inotropes are administered.

We aim to achieve at least 5 mmHg separation in mean/median mean arterial pressure for the three blood pressure groups targeting mean arterial pressure.

We aim to obtain data from more than 90% of patients still alive at 30- and 90-days follow-up.

A composite of the following based on European Perioperative Clinical Outcome definitions: Respirator infection, respirator failure, pleural effusion, atelectasis, pneumothorax, bronchospasms, and aspiration pneumonitis.

Based on the United States of America Centers for Disease Control and Prevention (CDC) definition of pneumonia

Presence of pulmonary embolus on computerized tomography (CT) or magnetic resonance (MR) imaging, or a high probability of pulmonary embolus based on ventilation perfusion scan.

Composite of post-operative renal complications using Kidney Disease Improving Global Outcomes (KDIGO) criteria

Measured in umol/L

Measured in umol/L

A composite of the following based on European Perioperative Clinical Outcome definitions: Non-fatal cardiac arrest, acute myocardial infarction, congestive heart failure, new cardiac arrhythmia, and angina.

Measured in ng/L

Measured in ng/L

Post-operative troponin-I above the 99% percentile for the respective assay.

Measured in U/L

Measured in U/L

Based on the nursing delirium screening scale to evaluate emergence delirium 90-120 minutes after admission to the post-aesthesia care unit.

We will categorize delirium as delirium if this is either stated in the medical journal or retrospectively categorized as delirium if it meets pre-defined criteria based on the diagnostic and statistical manual of mental disorders, fifth edition from the American psychiatric association

Highest numeric rating scale (NRS) score (from 0 to 10 with higher scores indicating worse pain) documented

Total opioid administered using morphine equivalent units.

Highest numeric rating scale (NRS) score (from 0 to 10 with higher scores indicating worse nausea and vomiting) documented

Administered antiemetic treatment (ondansetron, dexamethasone, cyclizine, droperidol, metoclopramide) within the first 24 hours after the operation.

Based on the United States of America Centers for Disease Control and Prevention (CDC) definition.

In addition to reporting the individual post-operative complications, we will use the validated Clavien-Dindo classification to grade post-operative complications by the interventions needed.

Both planned and unplanned stays at the intensive care unit.

Reported in days.

Reported in days. Patients that die during the 30 days, will receive a value of 0. All admissions at acute care hospitals in Denmark will be included in this outcome.

Based on the EQ-5D-5L questionnaire

Based on the EQ-5D-5L questionnaire

Specific complications occurring during the surgery: Bleeding, need of blood product transfusions, arrhythmia, pneumothorax, cardiac arrest, mortality.

Based on the quality of recovery-15 (QoR-15) score. The score ranges from 0-150 with higher scores indicating better recovery.

Based on the quality of recovery-15 (QoR-15) score. The score ranges from 0-150 with higher scores indicating better recovery.