Abstract
CHARGE syndrome is a rare congenital disorder with multisystem involvement, posing significant anaesthetic challenges. We report the perioperative management of an 11-month-old male who was diagnosed with anorectal malformation and CHARGE syndrome and who underwent posterior sagittal anorectoplasty. Key anaesthetic considerations included craniofacial asymmetry, facial nerve palsy, and anticipated airway difficulties. Inhalational induction with careful preoxygenation, video laryngoscopy, and caudal analgesia facilitated safe anaesthesia. Post-operative airway compromise was managed with continuous positive airway pressure, and the patient recovered without further complications or intervention. Ultrasound guidance may facilitate identification of relevant anatomy and real-time visualization of injectate spread during caudal block. This case highlights the importance of meticulous pre-anaesthetic planning and multidisciplinary evaluation in children with CHARGE syndrome.