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. Although meta-analyses of randomized controlled trials (RCTs) of high thoracic epidural anesthesia/ analgesia in CABG patients (particularly on-pump) have yielded inconsistent results on morbidity and mortality rates, it does appear to reduce time to extubation, pain, and pulmonary complications.36 38 Of interest, although none of the RCTs have reported the occurrence of epidural hematoma or abscess, these entities occur on occasion.38 Finally, the use of other regional anesthetic approaches for postoperative analgesia, such as parasternal block, has been reported.39 Over the past decade, early extubation strategies ( fast- track anesthesia) often have been used in low- to medium- risk CABG patients. 