Nondepo- larizing neuromuscular-blocking agents, particularly nonva- golytic agents with intermediate duration of action, are preferred to the longer-acting agent, pancuronium. Use of the latter is associated with higher intraoperative heart rates and a higher incidence of residual neuromuscular depression in the early postoperative period, with a resultant delay in extubation.23,34 In addition, low concentrations of volatile anesthetic usually are administered via the venous oxygenator during CPB, facilitating amnesia and reducing systemic vascular resistance. Outside the United States, alternative anesthetic tech- niques, particularly total intravenous anesthesia via propofol and opioid infusions with benzodiazepine supplementation with or without high thoracic epidural anesthesia, are com- monly used. The use of high thoracic epidural anesthesia exerts salutary effects on the coronary circulation as well as myocardial and pulmonary function, attenuates the stress response, and provides prolonged postoperative analge- sia.24,25,35 In the United States, however, concerns about the potential for neuraxial bleeding (particularly in the setting of heparinization, platelet inhibitors, and CPB-induced throm- bocytopenia), local anesthetic toxicity, and logistical issues related to the timing of epidural catheter insertion and management have resulted in limited use of these tech- niques.22 Their selective use in patients with severe pulmo- nary dysfunction (Section 6.5) or chronic pain syndromes may be considered. 