A fellowship-trained cardiac anesthesiologist (or ex- perienced board-certified practitioner) credentialed in the use of perioperative transesophageal echocar- diography (TEE) is recommended to provide or supervise anesthetic care of patients who are consid- ered to be at high risk.16 18 (Level of Evidence: C) Class IIa 1. Volatile anesthetic-based regimens can be useful in facilitating early extubation and reducing patient recall.5,19 21 (Level of Evidence: A) Class IIb 1. The effectiveness of high thoracic epidural anesthe- sia/analgesia for routine analgesic use is uncer- tain.22 25 (Level of Evidence: B) Class III: HARM 1. Cyclooxygenase-2 inhibitors are not recommended for pain relief in the postoperative period after CABG.26,27 (Level of Evidence: B) 2. Routine use of early extubation strategies in facilities with limited backup for airway emergencies or advanced respiratory support is potentially harmful. (Level of Evidence: C) See Online Data Supplement 1 for additional data on anes- thetic considerations. Anesthetic management of the CABG patient mandates a favorable balance of myocardial oxygen supply and demand to prevent or minimize myocardial injury (Section 2.1.8). Histori- cally, the popularity of several anesthetic techniques for CABG has varied on the basis of their known or potential adverse cardiovascular effects (eg, cardiovascular depression with high doses of volatile anesthesia, lack of such depression with high-dose opioids, or coronary vasodilation and concern for a steal phenomenon with isoflurane) as well as concerns about interactions with preoperative medications (eg, cardiovascular depression with beta blockers or hypotension with angiotensin- converting enzyme [ACE] inhibitors and angiotensin-receptor blockers [ARBs]28 30) (Sections 2.1.8 and 4.5). 