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Perioperative subcutaneous tissue oxygen tension (PsqO ) is substantially reduced in obese surgical patients. Goal-directed fluid therapy optimizes cardiac performance and thus tissue perfusion and oxygen delivery. We therefore tested the hypothesis that intra- and postoperative PsqO is significantly reduced in obese patients undergoing standard fluid management compared to goal-directed fluid administration. We randomly assigned 60 obese patients (BMI ≥ 30kg/m ) undergoing laparoscopic bariatric surgery to receive either esophageal Doppler-gu