Emanuel syndrome is associated with supernumerary chromosome, which consists of 
the extra genetic material from chromosome 11 and 22. The frequency of this 
syndrome has been reported as 1 in 110,000. It is a rare anomaly associated with 
multiple systemic malformations such as micrognathia and congenital heart 
disease. In addition, patients with Emanuel syndrome may have seizure disorders. 
We experienced anesthetic management of a patient with Emanuel syndrome who 
underwent palatoplasty. This patient had received tracheotomy due to 
micrognathia. In addition, he had atrial septal defect, mild pulmonary artery 
stenosis, and cleft palate. Palatoplasty was performed without any complication 
during anesthesia. Close attention was directed to cardiac function, seizure, 
and airway management.