Ischemic heart disease is the major cause of morbidity and mortality in the Western world. With the advancing age of the surgical population, anesthesiologists increasingly have to treat patients with known or suspected ischemic heart disease in the perioperative period. Over the years various strategies have been developed to prevent myocardial ischemia in the perioperative period and/or to minimize the extent of myocardial damage after perioperative ischemia. This review summarizes the current knowledge on the subject and focuses on the more recent data concerning perioperative cardioprotection by anesthetic agents.