An alternative approach that avoids much (but not all) of the safety concerns related to potential vascular injury is remote precondi- tioning of arterial inflow to the leg or (more commonly) the arm via blood pressure cuff occlusion.218 Two studies of patients undergoing on-pump CABG at a single center, the first of which used 2 different myocardial protection strategies and the second of which repeated the study with a standardized cold-blood cardioplegia routine, reported similar amounts of troponin re- lease during the 72 hours postoperatively, with no apparent complications.193,195 A larger trial was unable to confirm any benefits of a similar protocol, casting doubt on the utility of this Volatile halogenated anesthetics and opioids have anti- ischemic or conditioning properties,32,33,219,220 and propofol has antioxidant properties of potential value in subjects with reperfusion injury.221,222 The salutary properties of volatile anesthetics during myocardial ischemia are well known. Their negative inotropic and chronotropic effects are consid- ered to be beneficial, particularly in the setting of elevated adrenergic tone that is common with surgical stimulation. Although contemporary volatile agents demonstrate some degree of coronary arterial vasodilation (with isoflurane considered the most potent), the role of a steal phenomena in the genesis of ischemia is considered to be trivial.33 In comparison to propofol/opioid infusions, volatile agents seem to reduce troponin release, preserve myocardial function, and improve resource utilization (ie, ICU or hospital lengths of stay) and 1-year outcome.223 227 It is postulated that multiple factors that influence myocardial preservation modulate the potential impact of a specific anesthetic regimen. Observational analyses have reported an association be- tween elevated perioperative heart rates and adverse out- comes,228,229 but it is difficult to recommend a specific heart rate for all CABG patients. 