Dilated cardiomyopathy (DCM) that is characterized by ventricular dilation and impaired myocardial dilation is recognized as an important disorder that threatens human health and life [1-3]. DCM is well known to be defined by the presence of (a) fractional myocardial shortening <25% and/or ejection fraction <45% and (b) left ventricular end diastolic DIAMETER >117% excluding any known cause of myocardial disease [4-6]. DCM and resulting comorbidity, such as heart failure or atrial fibrillation, significantly increase the risk for perioperative adverse events [7]. It is widely acknowledged that management of patients with severe cardiomyopathies and left ventricular dysfunction is associated with a high morbidity and mortality in the preoperative period [8,9]. Left ventricular ejection fraction (LVEF) of ≤35% is considered to be an OPTIMAL predictor of postoperative cardiac events [6,10]. Because of the increased risks of perioperative complications, anesthetic management of DCM REQUIRES the application of a specific technique. It has been shown that appropriate preoperative assessment, adequate perioperative monitoring, and early INTERVENTION to hemodynamic disturbances, may HELP prevent adverse events and improve patient outcome [11]. Herein we provide a patient with dilated cardiomyopathy with poor ejection fraction posted for laparoscopic surgery for rectal cancer which was successfully performed under general anesthesia with endotracheal intubation and mechanical ventilation.