The risk of complications and duration of hospital stay can both be reduced by the use of a monitoring protocol to maximise haemodynamic flow during operation in patients having major abdominal and orthopaedic operations. We describe using a protocol for intraoperative fluid management and our early experience with it in patients having major head and neck surgery. (C) 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.