Anesthesia is commonly employed in aquatic medicine to facilitate physical exams, diagnostics, and surgical interventions. Tricaine methanesulfonate (MS-222) is the most commonly used anesthetic for fish and is currently the only anesthetic approved by the US Food and Drug Administration Center for Veterinary Medicine for food-producing fish. Despite the frequency of anesthetic procedures in fish, anesthetic monitoring remains rudimentary in many facilities. This study evaluated the impact on blood gases, acid-base balance, and electrolytes in koi (Cyprinus carpio) anesthetized at concentrations of 100 mg/L and 150 mg/L MS-222. Blood samples from 25 fish per treatment were collected at 5 and 20 min of anesthetic immersion. Forty-nine of 50 fish recovered uneventfully from anesthesia; one fish did not recover and was euthanatized. Results showed significant increases in partial pressure of carbon dioxide (pCO₂) (P = 0.006) and hyperglycemia (P = <0.0001) with increasing anesthetic concentration and time under anesthesia and a significant decrease in partial pressure of oxygen (pO₂) with increased anesthetic time (P = 0.021). There were several electrolyte changes observed with both increasing anesthetic time and concentration. All electrolytes except potassium remained within published reference ranges for koi, while potassium showed a significant decrease in concentration associated with anesthetic time and concentration. The results of this study indicate that MS-222 at 100 mg/L and 150 mg/L represent safe anesthetic concentrations for koi undergoing minimally invasive diagnostics; however, koi anesthetized with MS-222 at a concentration of 150 mg/L experienced more significant changes in blood gases, acid-base balance, and electrolyte concentrations.