I read with interest the Editorial by Sessler on the implications of practice variability. There is considerable interpatient variability in the response to surgical stress, hemodynamic perturbations, anesthetics, fluids, vasopressors, inotropic therapy, extracorporeal-circulation, hemotherapy, ischemia-reperfusion, and others, and also considerable interindividual variation in the incidence and severity of the perioperative complications. Although personalized or precision medicine is gaining implementation generally in disease prevention and treatment, the potential of precision perioperative medicine remains to be fully explored and implemented, such as in hemodynamic optimization, anesthetic regimens, pharmacologic therapy, pain management, mechanical ventilation, and other organ protective strategies. The guideline- and protocol-based perioperative approach constitutes the antithesis of precision medicine in perioperative practice. Nevertheless, the proponents of precision perioperative medicine embrace the notion that most of the standardized therapies are designed for an average patient and are...

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