Although meta-analyses of randomized controlled trials (RCTs) of high thoracic epidural anesthesia/ analgesia in CABG patients (particularly on-pump) have yielded inconsistent results on morbidity and mortality rates, it does appear to reduce time to extubation, pain, and pulmonary complications.36 38 Of interest, although none of the RCTs have reported the occurrence of epidural hematoma or abscess, these entities occur on occasion.38 Finally, the use of other regional anesthetic approaches for postoperative analgesia, such as parasternal block, has been reported.39 Over the past decade, early extubation strategies ( fast- track anesthesia) often have been used in low- to medium- risk CABG patients. These strategies allow a shorter time to extubation, a decreased length of intensive care unit (ICU) stay, and variable effects on length of hospital stay.4 6 Immediate extubation in the operating room, with or without markedly accelerated postoperative recovery pathways (eg, ultra-fast-tracking, rapid recovery protocol, short-stay intensive care ) have been used safely, with low rates of reintubation and no influence on quality of life.40 44 Obser- vational data suggest that physician judgment in triaging lower-risk patients to early or immediate extubation works well, with rates of reintubation 1%.45 Certain factors appear to predict fast-track failure, including previous cardiac surgery, use of intra-aortic balloon counterpulsation, and possibly advanced patient age. Provision of adequate perioperative analgesia is important in enhancing patient mobilization, preventing pulmonary complications, and improving the patient s psychological well-being.9,11 The intraoperative use of high-dose morphine (40 mg) may offer superior postoperative pain relief and enhance patient well-being compared with fentanyl (despite similar times to extubation).46 The safety of nonsteroidal anti-inflammatory agents for analgesia is controversial, with greater evidence for adverse cardiovascular events with the selective cyclooxygenase-2 inhibitors than the nonselective agents. 