Intraoperative hypovolemia and hypotension are common in high-risk prolonged surgeries, such as major abdominal or cardiac procedures, among vulnerable populations, including elderly patients and those with preexisting medical conditions, and are associated with high morbidity, risk of postoperative mortality, and adverse postoperative outcomes [1, 2].

Proper fluid therapy is an essential and critical component of intraoperative management. Its goal is to prevent and correct hypovolemia and hypotension while avoiding fluid overload. Fluid overload is harmful as it carries the risk of impaired tissue oxygenation, pulmonary edema, impaired wound healing, acute kidney injury (AKI), prolonged bowel dysfunction, and longer hospital stay in surgical patients [3, 4]. Adequate fluid therapy ensures proper tissue perfusion and oxygenation, which are crucial for maintaining optimal surgical outcomes.

Hypovolemia: To avoid hypovolemia and hypotension, along with appropriate fluid replacement, it is essential to diagnose and treat the underlying causes. Causes of intraoperative hypovolemia and hypotension include [5, 6]:

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