Introduction
As the number of older people increases the incidence of diseases amenable to definitive surgical intervention will increase. This will result in a greater number of older people undergoing surgery. Issues that become more prevalent with ageing, such as multimorbidity, functional dependence and frailty, contribute to adverse events after surgery.

Introduction
There are an estimated 313 million operations carried out worldwide every year[1], with over 4.2 million of these in England[2]. For a variety of reasons, it is difficult to gain a precise estimation of perioperative mortality and morbidity. However, it has been suggested that this may occur in between 3 and 17% of operations[3][4], with total UK inpatient surgical mortality up to 3.6%[5].

Introduction
At a time when the NHS is being faced with an ageing population with increasing complex needs and limited budget and resources, healthcare professionals need to be acutely aware that whilst we provide our patients with the best possible care we are mindful of cost effectiveness.

Introduction
Enhanced recovery has become a familiar term in recent years in the landscape of anaesthesia and perioperative medicine. The concept of “fast-track surgery” was first described by Henrik Kehlet in Denmark in the 1990s. Looking at the use of multimodal packages in patients undergoing open colorectal surgery, he was able to demonstrate reductions in postoperative length of stay (LOS) and morbidity. From this, the concept of enhanced recovery after surgery (ERAS) was born.

Introduction
It is a typical morning intensive care round. There is a septic, mechanically ventilated patient, who remains hypotensive despite aggressive fluid therapy overnight. The patient is dependent on vasopressors to meet with the targets of ‘early goal directed therapy’. A lively debate ensues with someone advocating a fluid bolus, whilst someone else feels the patient is already overloaded. How can the conflict be resolved? How can volume status be accurately assessed?