 An increasing number of operations to repair fractured necks of femur are being performed awake under spinal anaesthesia. Technology such as oesophageal Doppler is not suitable as it cannot easily be tolerated when awake, and arterial based pulse waveform analysis requires an invasive procedure to be performed. Hence many patients do not receive goal directed therapy even though it may be of clinical benefit. A recent economic analysis has also suggested that goal directed therapy in this group is not only cost effective but also associated with cost savings. 