Present and future of cardiothoracic anesthesia: An overviewCardiothoracic anesthesia may seem one of the most "traditionalist" subspecialties among anesthesia: cardiothoracic anesthesiologists intubate almost everyone, do very little locoregional anesthesia (especially in cardiac surgery), are still a long way from the fashionable "opioid-free anesthesia" concept [1], and are among the few who still use (and appreciate) the pulmonary artery catheter [2,3]. Some would say it is an old dinosaur destined for extinction just like cardiac surgery itself [4], but (s)he couldn't be further from the truth. First, cardiothoracic anesthesiology has a long tradition of continuous research and innovation to improve the outcome of complex procedures, which are often associated with marked hemodynamic impairment, major bleeding, and life-threatening complications. Moreover, not rarely cardiac surgery is performed in high risk patients due to age, frailty, comorbidities, or critical status. Hence, an increasingly refined and extensive monitoring, specific pharmacological and non-pharmacological perioperative interventions, and defined organ-protection strategies may be pivotal in improving clinically relevant outcomes and increasing survival after cardiothoracic surgery. Second, cardiothoracic surgery is a constantly and rapidly evolving field. On the one hand, improvements in perioperative hemodynamic management and intensive care procedures, as well as the availability of increasingly sophisticated and effective mechanical circulatory support devices allow complex invasive cardiothoracic surgery procedures to be performed relatively safely in elderly patients [5] and in patients with poor myocardial systolic function [6]. On the other hand, minimally invasive and hybrid cardiothoracic procedures are becoming increasingly more common. Cardiothoracic surgery of the future will no longer be considered as opposed to interventional cardiology, but rather it will become part (or one of the options) of a dynamic multidisciplinary approach [7] involving cardiologists, cardiothoracic surgeons, cardiac anesthesiologists, and dedicated intensive care practitioners (the last two now already often belonging to a single team of anesthesiologists/intensivists who deal with both perioperative and intensive care management). Accordingly, cardiothoracic anesthesiologists and intensivists will have to keep up with all this in order to face, at the same time, both less invasivity and greater complexity and level of risk.