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.