Intravenous anesthetics continue to be a mainstay in the modern anesthesiologist's armamentarium. In this review the authors will discuss new advancements in the use of propofol, as well as a greater understanding as to its mechanism of action. Further, we will discuss the use of target controlled infusion systems, touch upon the possible benefits of the ultra-short acting opioids, and consider the role of alpha-2 agonists as an adjunct to anesthetic management.