The anaesthetic management of 41 patients who underwent cardiac transplantation during a 40 month period at Clínica Puerta de Hierro is reviewed. The study includes the preoperative assessment, anaesthetic agents used and intraoperative incidences. The anaesthesia was induced with etomidate whereas a high-dose fentanyl, supplemented with diazepam, was the most commonly anaesthetic technique used. There was no intraoperative mortality in this series. Several interesting concerns related to the physiology of the denervated heart and the effects of vasoactive agents after extracorporeal circulation are reviewed.