ECG variations of characteristic coved-type patterns are a common finding in subjects with Brugada syndrome. Few data are available about patients with Brugada syndrome undergoing major surgery and requiring general anesthesia. We reported ECG serial variations in a patient with Brugada syndrome who underwent surgery for tibial fracture. Relevant variations of ST patterns in V1-V2 leads over 24-h ECG monitoring were detectable, albeit these modifications were not associated with incidence of arrhythmias.