A meta-analysis of 20 trials of patients undergoing thoracic or cardiac surgery, which evaluated studies published before 2005, reported significant reductions in pain scores, with no increase in adverse outcomes.49 Subsequently, 2 RCTs, both studying the oral cyclooxygenase-2 inhibitor valdecoxib and its intravenous prodrug, parecoxib, reported a higher incidence of sternal infections in 1 trial and a significant increase in adverse cardiovascular events in the other.26,27 On the basis of the results of these 2 studies (as well as other nonsurgical reports of increased risk with cyclooxygenase-2 selective agents), the U.S. Food and Drug Administration in 2005 issued a black box warning for all nonsteroidal anti-inflammatory agents (except aspirin) immediately after CABG.50 The concurrent administra- tion of ibuprofen with aspirin has been shown to attenuate the latter s inhibition of platelet aggregation, likely because of competitive inhibition of cyclooxygenase at the platelet-receptor Observational analyses in patients undergoing noncardiac surgery have shown a significant reduction in perioperative death with the use of checklists, multidisciplinary surgical care, intraoperative time-outs, postsurgical debriefings, and other communication strategies.14,15 Such methodology is being used increasingly in CABG patients.12 14 In contrast to extensive literature on the role of the surgeon in determining outcomes with CABG, limited data on the influence of the anesthesiologist are available. Of 2 such reports from single centers in the 1980s, 1 suggested that the failure to control heart rate to 110 beats per minute was associated with a higher mortality rate, and the other suggested that increasing duration of CPB adversely influenced outcome.52,53 Another observational analysis of data from vascular surgery patients suggested that anesthetic specialization was independently associated with a reduction in mortality rate.54 To meet the challenges of providing care for the increasingly higher-risk patients undergoing CABG, efforts have been di- rected at enhancing the experience of trainees, particularly in the use of newer technologies such as TEE. 