Cardiac arrhythmias are a significant cause of morbidity and mortality in the perioperative period. While literature on antiarrhythmic agent use in postoperative and non-surgical intensive care settings is expanding, randomized clinical trials examining the use of these agents in the perioperative period are scarce. Nonetheless, as our understanding of the relevant molecular targets for manipulating cardiac excitability grows, the range of options for treating arrhythmias during surgery expands. In the sections that follow, these molecular targets are used as a basis for clinical management strategies for arrhythmias in adults during surgery and anaesthesia. In addition, the controversy surrounding droperidol and its reported proarrhythmic effects will be addressed. Finally, since pacemakers and implantable cardioverter-defibrillators (ICD) have gained widespread use in the treatment of tachyarrhythmias and bradyarrhythmias, a basic understanding of their perioperative function and management is discussed.