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. Attention should be directed at preventing or minimizing adverse hemodynamic and hor- monal alterations that may induce myocardial ischemia or exert a deleterious effect on myocardial metabolism (as may occur during cardiopulmonary bypass [CPB]) (Section 2.1.8). This requires close interaction between the anesthesiologist and surgeon, particularly when manipulation of the heart or great vessels is likely to induce hemodynamic instability. During on-pump CABG, particular care is required during vascular cannulation and weaning from CPB; with off-pump CABG, the hemodynamic alterations often caused by dis- placement or verticalization of the heart and application of stabilizer devices on the epicardium, with resultant changes in heart rate, cardiac output, and systemic vascular resistance, should be monitored carefully and managed appropriately. In the United States, nearly all patients undergoing CABG receive general anesthesia with endotracheal intubation uti- lizing volatile halogenated general anesthetics with opioid supplementation. Intravenous benzodiazepines often are given as premedication or for induction of anesthesia, along with other agents such as propofol or etomidate. Nondepo- larizing neuromuscular-blocking agents, particularly nonva- golytic agents with intermediate duration of action, are preferred to the longer-acting agent, pancuronium. 