SMART TRENDS Study

Inclusion Criteria: * Signed informed consent * Age ≥ 18 years * ASA Physical Status ≥ 2 * Elective noncardiac surgery with expected surgery duration ≥ 3 hours and expected post-operative length of stay of ≥ 3 days * Planned monitoring with an arterial catheter; Cohort 2: without planned arterial catheter insertion * General anesthesia with tracheal intubation and positive pressure ventilation Exclusion Criteria: * Inability to comply with the study intra-operative hemodynamic management algorithm such as surgeon request for relative hypotension or fluid restriction or avoidance of vasopressors * Planned vasopressor or inotrope infusion during surgery * Contraindication to intra-arterial blood pressure monitoring * Has previously participated in the SMART TRENDS study * Serum creatine \> 2.0 mg/dL (\> 175 μmol/L) or CKD stage \> 3A * Scheduled for intracranial or cardiac surgery * Patient who is known to be pregnant * Patients on mechanical circulatory support * Emergency surgery * Planned beach-chair positioning Additional Exclusion Criteria for Cohort 2 only: * Extreme contraction of the smooth muscle in the arteries and arterioles of the lower arm and hand, such as may be present in patients with Raynaud's disease * Finger or hand deformity that prevents proper placement of finger cuff by visual inspection * Inability to place Acumen IQ finger cuffs due to subject anatomy, condition, or obstructive paraphernalia (such as false nails)