Congenitally corrected Transposition of the great Arteries (cc TGA) is a rare congenital cardiac anomaly in which the aorta and pulmonary artery are transposed, presenting unique anesthetic challenges. The patient’s cardiac physiology, characterized by atrioventricular and ventriculoarterial discordance characterized by abnormal ventricular loading and potential for arrhythmias, required meticulous pre-operative evaluation and careful anesthetic planning. We report the peri-operative anesthetic management of a 3 year old child with ccTGA scheduled for a posterior sagittal anorectoplasty (PSARP) for an anorectal malformation under general anaesthesia in prone position.