Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 Supp. 1 2022 11 07 420 422 Pooja Chandran Department of Anaesthesiology and Critical Care, AIIMS, Rishikesh, Uttarakhand, India. Ruby Perween Department of Anaesthesiology and Critical Care, AIIMS, Rishikesh, Uttarakhand, India. Boney John Department of Anaesthesiology and Critical Care, AIIMS, Rishikesh, Uttarakhand, India. Mohammed Shafiq Shajahan Department of Anaesthesiology and Critical Care, AIIMS, Rishikesh, Uttarakhand, India. Roopesh Ramesh Department of Anaesthesiology and Critical Care, AIIMS, Rishikesh, Uttarakhand, India. 2021 12 27 2022 01 30 In patients with cardiac disease, it’s always a challenge for the anaesthetist to administer general anaesthesia as well as central neuraxial blockade. The major perioperative task in these patients with low cardiac output is maintaining hemodynamic stability. Here, we are discussing a case of successful management of a geriatric patient having ischemic heart disease with ejection fraction of 25% posted for bilateral total knee replacement under graded epidural anaesthesia. https://aacc.tums.ac.ir/index.php/aacc/article/view/456