Protection from and treatment of myocardial ischemia involves detection and recognition of early changes in myocardial function associated with ischemia, as well as use of techniques and agents designed to alleviate or ameliorate ischemia. However, decisions regarding which agent(s) to employ depend upon not only the effects of a particular therapy but also the interaction(s) among the therapeutic agents and anesthetics. All the drugs and treatments discussed above may have beneficial effects in conscious patients but variable degrees of effectiveness during anesthesia. The choice of agents to be used for myocardial protection ultimately depends upon clinical decisions regarding coronary blood supply and myocardial oxygen demand. The availability of several different classes of agents capable of altering specific physiological variables allows a wide variety of clinical situations to be effectively managed.