Background: The objective of this study was to validate the impact of cardiac preconditioning (ischemic versus pharmacological) upon postoperative inotropic score in adult patient undergoing open heart surgery. Aim of Work: Is to validate the impact of Sevoflurane versus ischemic & Sevoflurane pc upon postoperative inotropic score in adult patient undergoing open heart surgery. Material and Methods: Thirty ASA II-III adult undergoing open heart surgery were included in the study. They were randomly allocated into2 groups, Group A (15 patients). Anaesthetized by Sevoflurane as a pharmacologic preconditioner, Group B (15 patient) ischemic preconditioning was done after induction and before cardiopulmonary bypass by inflation the cuff of blood pressure above 200mmhg in the lower limb every 5min for 3 cycles. Results: Non significant difference between the two groups regarding to the inotropic score and ICU stay. Conclusion: Both ischemic and pharmacological cardiac preconditioning could offer some sort of cardiac protection reflected upon inotropic score.