The field of cardiovascular anesthesiology is well established, with dedicated specialists, extra-year fellowship programs to provide subspecialty training, its own national specialty society, and a variety of specialty textbooks for reference. The practice of cardiovascular anesthesiology has centered around intraoperative general anesthetic management and intensive care of the vascular patient. The emerging multidisciplinary field of endovascular therapy brings different requirements to this practice. Anesthesiologists now must recognize the distinct logistic and clinical requirements that distinguish the inpatient cardiovascular surgical patient from the endovascular outpatient, since many of the latter will be able to undergo procedures requiring only pain management with monitored anesthesia care. Analgesic management differs from anesthesia, which modifies or suspends a variety of normal physiologic functions and carries risks and complications, necessitating additional effort and expense to avoid these unwanted effects. Recent advances in management of analgesia and sedation have made preservation of normal physiologic function in the operating room possible through the control of pain. This management will find appropriate application during endovascular procedures. The distinction will take advantage of the anesthesiologist’s consultative pain management skills and may eventually limit administration of anesthesia to operative surgical procedures.