Recent surgical advances have made it possible for multiple grafts without going on Cardio Pulmonary Bypass (CPB). The major Anesthetic challenge is the maintenance of hemodynamic stability during manipulation of the heart. Proven benefits of Off-pump Coronary Artery Bypass (OPCAB) include a reduction in requirement for blood and blood products and benefit to high risk patient. Good communication between surgeon and anaesthetist is vital for a successful outcome. The rationale for avoiding CPB in favour of Off pump Coronary Artery Bypass (OPCAB), has been the avoidance of the complications of CPB including systemic inflammatory response, coagulopathies, platelet dysfunction, accelerated fibrinolysis, depletion of clotting factors, neurological injury and renal impairment. With the improvement of surgical techniques and the development of cardiac stabilizing retractors, OPCAB has become an established procedure. Over the last 3 years at the Karen hospital we have done 64 OPCABG with good outcome. This technique could be a good alternative to conventional Coronary Artery Bypass Surgery (CABG), where centres with restricted surgical packages.