Posterior fossa tumor surgeries are challenging from the point of view of both surgeons and anesthetists owing to the proximity of the tumor to vital centers, the difficulty faced in approaching the tumor, and complications associated with the positioning. The challenge in this patient undergoing a sitting-position craniotomy for a left-sided acoustic schwannoma was further augmented by the presence of a complete heart block in our patient (for which a pacemaker had been inserted) and the co-existence of a moderate aortic regurgitation.