This chapter focuses on the adult cardiothoracic anaesthesia and critical care, and assesses their impact on practice. A recent meta-analysis found that, in the treatment of pneumothorax or for minor resections, video-assisted thorascopic surgery (VATS) was associated with a shorter hospital stay, less pain and less analgesic administration than conventional thoracotomy. Currently, by far the most controversial aspect of cardiac anaesthesia is the use of spinal or epidural analgesia. Combinations of glucose, potassium and insulin (GKI) have long been advocated to improve outcome from heart surgery. A meta-analysis found that there had been no therapeutic trials of fresh frozen plasma (FFP) and that the prophylactic intraoperative administration of FFP was not associated with reduced blood loss. Finally, there are many important aspects of cardiothoracic anaesthesia and critical care that have not been subjected to randomised controlled trials (RCTs) far less meta-analysis.