Four major factors affecting anesthetic choices in surgery include the requirements of surgery (including type and location), anesthesiologist's experience and expertise, patient's preference, and the surgeon's preference. Especially, the type and location of surgical procedure may limit anesthetic techniques and choice of anesthetic agents. Available anesthetic techniques consist of three basic options: regional anesthesia, monitored anesthesia care (MAC), and general anesthesia. Recent advances in nerve stimulators and ultrasound guidance devices help to make regional blocks more successful with less complications. MAC is increasingly used with given advantages of supplying sedation, anxiolysis, additive analgesia, and improved safety to patients. Remarkable advances in general anesthesia include total intravenous anesthesia (TIVA) and fast-track anesthesia to use drugs with rapid action and short duration including propofol, desflurane, and sevoflurane, and advanced equipments such as target-controlled infusion pumps and monitoring devices of anesthetic depth. Advances in medical technology and pharmacology will continue to develop newer anesthetic agents, techniques, and patterns.