Temporary cardiac pacing may provide definitive, and even life-saving, therapy for transient bradyarrhythmias or as a bridge to permanent pacemaker placement. Other dysrhythmias may also be amenable to therapy with temporary pacemakers. Serious dysrhythmias may develop perioperatively because of a patient's underlying disease state, drug administration, and/or intraoperative events. The aging nature of the surgical population and the increasing complexity of surgical patients' medical problems will no doubt contribute to a greater likelihood of encountering perioperative rhythm disturbances. It is therefore essential that anesthesiologists be knowledgeable regarding the indications and contra-indications for temporary pacing in the perioperative period. This article describes the numerous potential indications for temporary pacing. Anesthesiologists similarly need to be familiar with the array of temporary pacing techniques currently available. The techniques reviewed include transvenous pacing, pacing pulmonary artery catheters, transcutaneous pacing, esophageal pacing, and transthoracic pacing. By combining a working understanding of the use of these techniques with the technical skills necessary to implement these temporary pacing modalities, the anesthesiologist should be able to successfully establish temporary cardiac pacing. Copyright (C) 2000 W. B. Saunders Company.