HEN FORMULATING an anesthetic plan, the anesthesiologist deliberates over numerous therapeutic decisions. Perhaps chief among these is whether to proceed with an inhalation or intravenous anesthetic technique. Although there are many differences between the 2 approaches, they differ most fundamentally in terms of how the anesthesiologist gains access to the circulation for delivery of the anesthetic. This brief review aims to compare and contrast inhalation anesthesia with total intravenous anesthesia (TIVA) from a drug delivery perspective, making the case that advances in TIVA drugs, clinical pharmacology concepts, technologies, and techniques over the last 25 years have transformed TIVA into an attractive alternative to more traditional inhalation anesthesia methods.