Histori- cally, the popularity of several anesthetic techniques for CABG has varied on the basis of their known or potential adverse cardiovascular effects (eg, cardiovascular depression with high doses of volatile anesthesia, lack of such depression with high-dose opioids, or coronary vasodilation and concern for a steal phenomenon with isoflurane) as well as concerns about interactions with preoperative medications (eg, cardiovascular depression with beta blockers or hypotension with angiotensin- converting enzyme [ACE] inhibitors and angiotensin-receptor blockers [ARBs]28 30) (Sections 2.1.8 and 4.5). Independent of these concerns, efforts to improve outcomes and to reduce costs have led to shorter periods of postoperative mechanical ventila- tion and even, in some patients, to prompt extubation in the operating room ( accelerated recovery protocols or fast-track High-dose opioid anesthesia with benzodiazepine supple- mentation was used commonly in CABG patients in the United States in the 1970s and 1980s. Subsequently, it became clear that volatile anesthetics are protective in the setting of myocardial ischemia and reperfusion, and this, in Hillis et al 2011 ACCF/AHA CABG Guideline e657 combination with a shift to accelerated recovery or fast- track strategies, led to their ubiquitous use. As a result, opioids have been relegated to an adjuvant role.32,33 Despite their widespread use, volatile anesthetics have not been shown to provide a mortality rate advantage when compared with other intravenous regimens (Section 2.1.8). Optimal anesthesia care in CABG patients should include 1) a careful preoperative evaluation and treatment of modifi- able risk factors; 2) proper handling of all medications given of central venous access and careful cardiovascular monitor- ing; 4) induction of a state of unconsciousness, analgesia, and immobility; and 5) a smooth transition to the early postoper- ative period, with a goal of early extubation, patient mobili- zation, and hospital discharge. 