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 Perioperative central circulation and oxygen transport in the elderly Julia Jakobsson, Division for Anaesthesia and Intensive Care [email protected] Background: Despite improvement in perioperative care, elderly patients with multiple comorbidities undergoing major or complex surgical procedures still contribute to the lion's share of surgery‐related deaths and carry a substantial risk of prolonged hospital stay and ICU admission due to complications. Increasing oxygen delivery to pre‐set goals is central to goal‐directed hemodynamic therapy (GDHT), a concept that has shown to reduce complications in high‐risk surgical patients. In the recent years, large randomized controlled trials has failed to reproduce the results from earlier studies. The benefit of GDHT by increasing oxygen delivery has been questioned in elderly, frail patients. Characterization of hemodynamic changes and oxygen transport during and after anaesthesia and surgery as well as indicators of oxygen debt are key steps to optimize perioperative care and outcome for this high‐risk surgical population. Purpose and aims: i) systematically describe the perioperative hemodynamic changes and oxygen transport elderly patients undergoing major or complex surgery ii) explore oxygen extraction ratio and potential indicators/biomarkers of oxygen debt in relation to postoperative complications. Studies: 1. A clinical observational study on hemodynamic changes and oxygen delivery in elderly patients (>65 yrs) undergoing arthroplasty in spinal anaesthesia given circulatory support according to current routine clinical guidelines. 2. A systematic review and meta‐analysis on the effect of anaesthesia and surgery on oxygen consumption. The results from this study will help designing study 3 and 4. 3. An clinical observational study with pre‐, intra‐ and postoperative measurements of oxygen consumption and oxygen delivery in elderly high‐risk patients (≥65 yrs, complex/major surgery according to SORT) to identify oxygen debt intra‐ and postoperatively. 4. An clinical observational study of perioperative oxygen extraction ratio and markers of anaerobic metabolism in elderly patients undergoing high risk surgery in relation to postoperative complications (continuation of study 3). Clinical significance: By identifying inadequate oxygen transport and hemodynamic responses in elderly high‐risk surgical patients, tailored algorithms for perioperative circulatory support can be designed to reduce postoperative morbidity and mortality.