Children with uncorrected cyanotic congenital heart diseases can present for non 
cardiac surgeries. They pose several challenges to the Anaesthesiologist, 
especially when they are posted for emergency surgery, due to the complex 
haemodynamic changes secondary to the heart disease. Pentalogy of Fallot (POF) 
is a rare form of congenital heart disease characterized by the association of 
Tetralogy of Fallot (TOF) with an atrial septal defect (ASD). TOF is the leading 
cause of intracardiac right to left shunt and is the commonest type of cyanotic 
congenital heart disease to cause a brain abscess. Children with POF presenting 
with brain abscess pose several challenges to the anaesthesiologist due to the 
altered haemodynamics and warrant a meticulous anaesthetic plan. There are very 
few case reports of Anaesthesia management of a child with Pentalogy of Fallot 
(POF) presenting for non cardiac surgery. We report the anaesthetic management 
of a rare case of a 5-year-old child with uncorrected POF, who presented to our 
Superspeciality hospital with a brain abscess and underwent an emergency 
craniotomy with drainage of the brain abscess successfully.