Volatile-based anesthesia can be useful in reducing the risk of perioperative myocardial ischemia and infarction.178 181 (Level of Evidence: A) Class IIb 1. The effectiveness of prophylactic pharmacological therapies or controlled reperfusion strategies aimed at inducing preconditioning or attenuating the ad- verse consequences of myocardial reperfusion injury or surgically induced systemic inflammation is un- certain.182 189 (Level of Evidence: A) 2. Mechanical preconditioning might be considered to reduce the risk of perioperative myocardial ischemia and infarction in patients undergoing off-pump CABG.190 192 (Level of Evidence: B) 3. Remote ischemic preconditioning strategies using pe- ripheral-extremity occlusion/reperfusion might be con- sidered to attenuate the adverse consequences of myo- cardial reperfusion injury.193 195 (Level of Evidence: B) 4. The effectiveness of postconditioning strategies to at- tenuate the adverse consequences of myocardial reper- fusion injury is uncertain.196,197 (Level of Evidence: C) See Online Data Supplements 2 to 4 for additional data on preconditioning. Hillis et al 2011 ACCF/AHA CABG Guideline e663 Perioperative myocardial injury is associated with adverse outcomes after CABG,198 200 and available data suggest a direct correlation between the amount of myonecrosis and the likelihood of an adverse outcome198,201 204 (Section 5.2.4). The etiologies of perioperative myocardial ischemia and infarction and their complications (electrical or mechanical) range from alterations in the determinants of global or regional myocardial oxygen supply and demand to complex biochemical and microanatomic, systemic, or vascular abnor- malities, many of which are not amenable to routine diagnos- tic and therapeutic interventions. Adequate surgical reperfu- sion is important in determining outcome, even though it may initially induce reperfusion injury. 