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There is a well known association of rheumatoid arthritis with coronary artery disease. We report a 59 year old male patient with rheumatoid arthritis who underwent off pump coronary artery bypass grafting(OPCAB). He had extensive arthritis and contractures involving all major joints. There was restriction of all movements in the neck though mouth opening was adequate. The cannulation of radial and femoral arteries was difficult because of the contractures in the wrist and hip joints. Intubation was difficult and was accomplished with intubating bougie. Post operatively the patient developed plate atelectasis. The various anaesthetic implications of rheumatoid arthritis in OPCAB and their effective management are discussed.