Introduction: Spina bifda is a major birth defect that is a result of failure of the  neural tube to close in the developing fetus. It is associated with varying degrees of  neurologic impairment. The anatomic level of the lesion generally correlates with the neurologic motor and sensory defcit and ranges from complete paralysis to  minimal or no motor defcit. Case Report: A 3 year old male child who was diagnosed with spina bifda was  posted for spina bifida surgery. The patient had swelling in the lower back region associated with right lower limb weakness since birth. Patient developed continuous dribbling of urine. An MRI Lumbar spine was done which showed  defect in the S1, S2, and S3 vertebrea with posterior herniation of spinal cord,
neural placode and nerve roots which is suggestive of closed spinal dysarphism, spina bifda with lipo-myelocoele. After through pre anaesthetic check-up, patient was posted for surgery. Patient was intubated with 4.5mm portex uncuffed endo tracheal tube and patient was  kept in prone position. Standard monitoring was ensured intra operatively. With a  total blood loss of 150ml which is within the maximum allowable blood loss limit, and total of 600ml of IV ?uids were given to prevent volume overload.
Neurosurgeon wanted an awake test which was a challenge for us as patient was on uncuffed tube so, electromyography was used and TIVA with propofol was maintained to check after the corrective surgery. After the surgery patient was
shifted to pediatric intensive care unit with ET tube in situ. Patient was extubated  the following day.  Conclusion: As the pediatric patient was posted for spina bifda surgery which is a major surgery which took around 6-7 hours. Blood loss, ?uid status, pain post   operative hypoxia were of major concern. Amount of IV ?uids to be given  intra-operatively, maximum allowable blood loss were calculated prior to surgery. The anaesthetic management was successfully done here  without any adverse events.
Key Messages: Folic acid supplementation during pregnancy can prevent   this defect that can happen as a congenital defcit and complications. Mortality and morbidity can be prevented with folic acid supplementation,  early diagnosis or screening and early intervention. Our patient was  a3 year old with defcits operated with planning with a with a multi  disciplinary team and with a successful outcome.