This article has been selected for the ANESTHESIOLOGY CME Program. Learning objectives and disclosure and ordering information can be found in the CME section at the front of this issue. P RACTICE advisories are systematically developed reports that are intended to assist decision-making in areas of patient care. Advisories are based on a synthesis of scientific literature and analysis of expert opinion, clinical feasibility data, open forum commentary, and consensus surveys. Advisories developed by the American Society of Anes-thesiologists (ASA) are not intended as standards, guidelines, or absolute requirements, and their use cannot guarantee any specific outcome. They may be adopted, modified, or rejected according to clinical needs and constraints. The use of practice advisories cannot guarantee any specific outcome. Practice advisories summarize the state of the literature and report opinions obtained from expert consultants and ASA members. Practice advisories are not supported by scientific literature to the same degree as standards or guidelines because of the lack of sufficient numbers of adequately controlled studies. Practice advisories are subject to periodic revision as warranted by the evolution of medical knowledge, technology, and practice. This document updates the "Practice Advisory for the Perioperative Management of Patients with Cardiac Rhythm Management Devices: Pacemakers and Implantable Cardioverter-Defibrillators, adopted by the ASA in 2004 and published in 2005.* Methodology A. Definition of Cardiac Implantable Electronic Devices For this Advisory, a cardiac implantable electronic device (CIED) refers to any permanently implanted cardiac pacemaker or any implantable cardioverter-defibrillator (ICD). The term CIED also refers to any cardiac resynchronization device. † B. Purposes of the Advisory The purposes of this Advisory update are to (1) facilitate safe and effective perioperative management of the patient with a CIED and (2) reduce the incidence of adverse outcomes. Perioperative management refers to the preoperative, intraoperative, postop-Updated by the