Purpose of Review <p>A fundamental task of anaesthetists is to ensure optimal end-organ perfusion managing the complex physiological processes that occur at the level of both the macro and microcirculation. The importance of maintaining blood pressure is clear, yet the patient and economic impacts of post-operative complications remain significant and constitute the ‘hidden pandemic’, with 30-day postoperative mortality the third leading cause of death globally. Work to optimise perioperative outcomes must continue if this is to be addressed.</p> Recent Findings <p>Evidence and particularly more recent findings targeting personalised haemodynamic goals and monitoring in at risk patients may reduce perioperative cardiovascular morbidity and mortality. This review advocates for personalized, advanced haemodynamic monitoring and goal-directed therapy, based on cardiovascular endotypes and extending this into the post-operative period. Advances in technology including continuous post-operative monitoring delivered in enhanced care units and automation have significant potential to assist in delivering this approach.</p> Summary <p> Rigorously evaluating perioperative haemodynamic management will require complex studies and efficient trial methodologies such as adaptive trial designs. We believe the shift from reductionist, reactionary care to pre-emptive, precision care has the potential to address the hidden pandemic of postoperative morbidity and mortality.</p>