Recent Advances in Cardiothoracic Anaesthesia: A Scoping Review of Innovations, Outcomes, and Future Directions

Background: Cardiothoracic anaesthesia has rapidly evolved owing to advances in monitoring, pharmacology, and perioperative care. Increasingly complex surgical techniques have positioned anaesthetists as key contributors to optimising outcomes, minimising complications, and supporting enhanced recovery. Despite these developments, the evidence base remains fragmented, emphasising the need for a comprehensive synthesis of recent progress. Objectives: This scoping review summarises recent innovations in cardiothoracic anaesthesia, assesses their effects on perioperative and long-term outcomes, and highlights priorities for future research and practice. Methods: The review followed Arksey and O'Malley's framework and PRISMA-ScR guidelines. Major databases (PubMed, Embase, Scopus, Web of Science, and Cochrane Library) were searched for articles published from 2010 to 2025. Eligible studies reported empirical research on innovations in monitoring, pharmacology, intraoperative techniques, or perioperative care in cardiothoracic anaesthesia. Data were thematically organised under innovations, outcomes, and future directions. Results: Key innovations included advanced transesophageal echocardiography, near-infrared spectroscopy, AI-assisted monitoring, short-acting pharmacological agents, multimodal analgesia, and fast-track anaesthesia protocols. These advances were associated with improved patient outcomes, such as reduced morbidity, earlier extubation, shorter ICU stays, and enhanced recovery. Healthcare systems benefited from decreased costs and resource utilisation. Future directions focus on precision medicine, AI-driven decision support, tele-anaesthesia, and global implementation of scalable innovations. Conclusion: Cardiothoracic anaesthesia is entering a transformative era characterised by precision, digital integration, and inclusivity. Although perioperative care and outcomes have improved, gaps remain in long-term evidence, paediatric populations, and global applicability.