Whipple surgery is a complex abdominal procedure associated with a high risk of hemodynamic instability and splanchnic hypoperfusion leading to anastomotic leaks, delayed gastric emptying, and organ dysfunction Traditional markers (e.g., MAP, mixed venous oxygen saturation \[SvO₂\], lactate) are indirect, invasive and often delayed.
CO₂-derived variables (e.g., venous-to-arterial CO₂ gap \[ΔCO₂\], tissue CO₂ \[PtCO₂\], end-tidal CO₂ \[EtCO₂\] changes) provide earlier and more sensitive signs of microcirculatory dysfunction.
Adults (>18 years) undergoing open Whipple procedure under general anesthesia
Invasive monitoring (arterial line and central venous catheter)
Informed written consent
Emergency surgery.
Preoperative septic shock or hemodynamic instability.
severe pre-existing **cardiopulmonary disease (e.g., severe COPD, heart failure).