Aim: This study aimed to evaluate the impact of preoperative imaging-guided anesthesia planning on postoperative recovery in critically ill patients undergoing major surgery. By integrating imaging modalities into anesthesia management, we assessed improvements in intraoperative stability, postoperative recovery, and overall patient outcomes. Materials and Methods: A prospective study was conducted at a tertiary care hospital, enrolling 100 critically ill patients (ASA III–IV) scheduled for major surgery. Patients were divided into two groups: the imaging-guided group (n = 50), where anesthesia planning was based on preoperative imaging findings, and the standard care group (n = 50), where conventional preoperative assessments guided anesthesia. Imaging modalities included CT, MRI, and ultrasound, used for airway evaluation, vascular access planning, and cardiac function assessment. Postoperative recovery parameters, including time to extubation, pain scores, pulmonary complications, ICU length of stay, and 30-day morbidity and mortality rates, were analyzed. Results: Preoperative imaging significantly influenced anesthesia planning, resulting in increased use of regional anesthesia (40% vs. 20%, p = 0.02) and improved hemodynamic stability. The imaging-guided group exhibited faster extubation times (4.5 ± 1.2 hours vs. 6.8 ± 1.6 hours, p = 0.001), lower pain scores (VAS: 3.2 ± 1.1 vs. 4.5 ± 1.3, p = 0.005), and a reduced incidence of pulmonary complications (10% vs. 22%, p = 0.03). ICU stays were significantly shorter in the imaging-guided group (5.2 ± 2.1 days vs. 7.4 ± 2.5 days, p = 0.004), and 30-day morbidity rates were lower (18% vs. 30%, p = 0.04). While 30-day mortality was lower in the imaging-guided group (6% vs. 12%), this difference was not statistically significant (p = 0.12). Conclusion: Preoperative imaging-guided anesthesia planning enhances patient outcomes by improving airway management, optimizing anesthesia strategies, and reducing postoperative complications. This approach leads to faster recovery, shorter ICU stays, and lower morbidity rates, demonstrating its potential as a valuable tool in perioperative management for critically ill patients.