This editorial argues that neuroanesthesiologists must move from passively adopting AI tools to actively co-developing them, since clinical expertise in brain-anesthesia physiology, multimodal neuromonitoring, and perioperative uncertainty is essential for building systems that are genuinely useful and safe. The author contends that the “black box” problem is less about algorithmic transparency and more about ensuring clinicians with the right domain knowledge are meaningfully involved throughout an AI system’s development, validation, and deployment.