Our review of the literature of the major cardiovascular journals for the past three years showed that for all studies using anesthesia for mouse echocardiography, the predominant anesthetic was isoflurane, which was used in 76% of the studies. The goal of this investigation was to determine if isoflurane is indeed the best anesthetic. Accordingly, we compared isoflurane with 2,2,2-tribromoethanol (Avertin), ketamine-xylazine, and ketamine on different days in the same 14 mice, also studied in the conscious state without anesthesia. A randomized crossover study design was employed to compare the effects on left ventricular (LV) systolic function and heart rate of the four different anesthetic agents assessed by transthoracic echocardiography. As expected, each anesthetic depressed LV ejection fraction and heart rate when compared with values in conscious mice. Surprisingly, isoflurane was not the best, but actually second to last in maintaining normal LV function and heart rate. The anesthetic with the least effect on LV function and heart rate was ketamine alone at a dose of 150 mg/kg, followed by Avertin at 290 mg/kg, isoflurane at 3% induction and 1 to 2% maintenance, and lastly ketamine-xylazine at 100 and 10 mg/kg, respectively. In summary, these results indicate that ketamine alone exerts the least depressant effects on LV function and heart rate, with Avertin second, suggesting that these anesthetics should be used when it is not feasible to study the animals in the conscious state as opposed to the most commonly used anesthetic, isoflurane.echocardiography; mice; conscious state; anesthetics TRANSTHORACIC ECHOCARDIOGRAPHY is an essential noninvasive tool for the assessment of cardiovascular function in mice. Currently, echocardiography is either performed consciously or under anesthesia. As a general rule, the conscious study is preferred because it eliminates the complicating influences of anesthesia on cardiac function and regulation by the autonomic nervous system. The concept of the superiority of studies in conscious animals as opposed to anesthetized animals are largely based on studies of chronically instrumented animals that were recorded in the conscious state without being touched or manipulated by the investigators (10, 12). While echocardiography also has these advantages in patients, who understand that the transducer is harmless, conscious rodents are wary of a transducer touching their skin. Accordingly, it is possible to argue that light anesthesia affects the rodent's cardiovascular system less than the application of the echocardiographic transducer in the conscious state. Therefore, it becomes important not only to compare echocardiographic studies in mice in the conscious state or during anesthesia but also to compare the effects of the different anesthetics that have been used in mouse echocardiography, which were the goals of the current investigation.To address these goals, we first reviewed the frequency of mouse echocardiography studies in conscious versus anesthetized animals an...