Tetralogy of Fallot is a cyanotic congenital heart disorder and includes ventricular septal defect, right ventricular outflow tract obstruction (pulmonic stenosis), right ventricular hypertrophy and overriding of aorta. Anaesthetic goals in these patients is to maintain or increase the systemic vascular resistance minimize pulmonary vascular resistance and provide mild cardiac depression. Here we present a report of anaesthetic management of a 5 year old boy with tetralogy of fallot coming for cleft lip and cleft palate repair.