One of the major determinants of the function of the heart is given by the left ventricular ejection fraction. Patients with congestive heart failure have a low ejection fraction and this increases the risk of perioperative adverse cardiac events and sometimes death1. It also changes the plan of anaesthesia along with the outcome. The major goal perioperatively is to maintain hemodynamic stability[1], also maintaining forward flow, promoting inotropy without inducing or exacerbating ischemia and returning patient to their preoperative level of function after surgery[2,3]. In this report we present a 60-year-old male with ischemic heart disease with left ventricular ejection fraction 30% who underwent penectomy under saddle anaesthesia without any complications. We believe that saddle anaesthesia can be a useful alternative anaesthetic technique in patients with low ejection fraction undergoing penectomy for carcinoma of penis. We showed evidence-based and customized anaesthetic management of a high-risk patient with available equipments and resources[1,4].