Fetal hydantoin syndrome is a rare disorder that is believed to be caused by 
exposure of a fetus to the anticonvulsant drug phenytoin. The classic features 
of fetal hydantoin syndrome include craniofacial anomalies, prenatal and 
postnatal growth deficiencies, underdeveloped nails of the fingers and toes, and 
mental retardation. Less frequently observed anomalies include cleft lip and 
palate, microcephaly, ocular defects, cardiovascular anomalies, hypospadias, 
umbilical and inguinal hernias, and significant developmental delays. 
Anaesthesia for incidental surgery in such a patient poses unique challenges for 
the anesthesiologist. We report the successful management of a 4-year-old male 
child with fetal hydantoin syndrome, cleft palate, spina bifida, atrial septal 
defect, and dextrocardia for tibialis anterior lengthening under subarachnoid 
block.