LTHOUGH OVERALL mortality after cardiac surgery has decreased in recent decades, this process has been partially offset by changes in the patient population involving more complex disease and significant comorbidity. 1 Perioperative morbidity has stayed roughly the same and remains a relevant burden to health care providers. Attempts to identify independent risk factors for cardiac surgery are complex and include patient factors as expressed in the EuroSCORE or Parsonnet score, surgical technique, and the presence or absence of systematic goal-directed protocols. 2 However, the contribution of anesthesia is largely unknown. With the availability of newer and shorter acting intravenous (IV) and volatile anesthetic agents, cardiac anesthesia fundamentally has shifted from a high-dose opioid/narcotic technique in recent years to a more balanced, synergistic approach. This shifted paradigm also has led to an emphasis on early tracheal extubation with application of multimodal analgesia including local anesthetic techniques resulting in the establishment of safe and effective fast-track protocols. 3,4 Modern anesthesia techniques for cardiac surgery need to offer qualities that go beyond safety alone.