Anesthesiology, like any other specialty in medicine, is continuously evolving. Perhaps the most important changes are driven by applications of physics leading to improved monitoring, as well as by advances in pharmacology (e.g., improved understanding of drug targets). TIVA (total intravenous anesthesia) is an extension of the concept of balanced anesthesia using real-time pharmacokinetic modeling, delivering all anesthetic drugs via intravenous route targeted to achieve optimal operating conditions with maximal patient comfort and safety. However, there is a natural reluctance among physicians, in general, and anesthesiologists, in particular, to change their practice unless the advantages are striking or the established techniques are proven unsafe. This is probably the main reason why intravenous anesthesia is not being embraced as fondly as one might have expected. Coupled with this, the issues related to modalities of administration are not yet perfected and the pharmacological principles on which they are based are constantly evolving. The aim of the chapter is to explore briefly the intricacies of intravenous anesthesia, examine the potential advantages, briefly review the disadvantages, and wrap up with the areas where it is inevitable and areas where it is immensely useful.