A 19-year-old male patient with transplanted heart received endoscopic sinus surgery. He was with X-linked dilated cardiomyopathy, and was one year after the transplantation. Preanesthetic study showed lactate dehydrogenase elevation estimated to have derived from striated muscle. Heart function was normal, and other abnormal findings were not revealed. Total intravenous anesthesia was performed with propofol target controlled infusion and remifentanil. Rocuronium was administered only for oro-tracheal ntubation. After the operation, train-of-four ratio was 95%, and he awoke from anesthesia smoothly. We did not use atropine, neostigmine or sugammadex to reverse neuromuscular blockade. No inotropic agent was administered. He was discharged from the hospital 5 days after the operation without any complications. We used usual anesthetic management but we had to be careful about both denervated heart and myopathy.
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