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Cardiac patients with pacemaker presenting for noncardiac surgery pose a considerable challenge to the anesthesiologists. In the United States it is said that there are more than 500,000 patients with pacemaker and every year more than 115,000 devices are implanted. Intraoperative care of the pacemaker as well as understanding its anesthetic implication is crucial in the management of these high-risk patients. We hereby present a case of an 85-year-old male posted for plating of tibial fracture with k-wiring of radius fracture who had permanent cardiac pacemaker in situ.