The VIRTUOSE (Virtual assistant for anesthesia and critical care) Project aims to reduce by half the risk of perioperative complications due to sub-optimal anesthesia management by providing an optimal knowledge of patient's physiological state and by contributing to a more “intelligent” administration of anesthesia drugs (“the right dose at the right time”). To that purpose, we will develop a combined alarm & decision support system – or virtual assistant – based on predictive digital twins that integrates all information available on a patient under anesthesia in a unified form. The system will combine biophysical models and statistical models using the patient's physiological signals for optimized use of monitoring data – i.e. augmented monitoring. This augmented cardiovascular and cerebral monitoring will provide a global vision of the patient's condition and will help guide physicians' therapeutic choices by recommending personalized medical strategies. By doing so, we aim at markedly improve patients’ conditions and quality of life after surgery. The VIRTUOSE project is in line with the perspectives of tomorrow's healthcare, combining personalized medicine, multidisciplinary research (biology, signal processing or artificial intelligence), while being committed to ethical and environmental concerns. Surgery under general anesthesia is today one of the most frequent procedures in medicine. General anesthesia is performed in more than 300 million times worldwide in 2020 and 12 million in France. Although artificial intelligence can help surgeons to better prepare for upcoming procedures with access to simulations beforehand and to monitor blood flow, anatomy, and physiology in real-time in the operating theater, few attempts have been made to introduce AI in anesthesia procedures. The VIRTUOSE project brings together partners from academia, hospital and industry, to develop a complete decision support system – or virtual assistant – based on digital twins that integrates all information available on a patient under anesthesia with the aim to optimize per-operative management and to reduce the risk of perioperative complications. The coordinator (AP-HP) along with the other 4 university-hospitals (Basel, Ulm, Karolinska, Edinburgh), representative of European population, will bring the clinical validation to the digital twins developed in the project. AP-HP will also bring expertise on the patient’s digital twin for the brain and collaborate together with Inria that already has significant data on cardiovascular digital twin. In addition, VIRTUOSE will set up a Personalized Anesthesia Report that describes patients’ reaction to anesthetic and surgical challenges and summarize cardiovascular and cerebral status. This report will be distributed to all professionals and will guide the patient's future management. To follow contemporary ethical rules, VIRTUOSE will include patients who were anesthetized to participate in the process of co-constructing the technology.