Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 3 2023 12 19 293 295 Shalvi Mahajan Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India. Kirandeep Kaur Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India. Priya Thappa Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India. Aparna Deperu Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India. Vinitha Narayan Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India. 2023 05 15 2023 06 28 Acute lymphoblastic leukemia (ALL) is the most common hematological malignancy in the pediatric age group. Anesthesia in such patients necessitates special considerations, in terms of disease progression and its respective treatment as well. We present a case of a 2-year-old child, a known case of ALL posted for drainage of multifocal brain abscess under general anesthesia. Anesthetic management of children with ALL presenting for neurosurgical procedures should focus on disease and its various systemic manifestations, treatment-related side effects, and anesthetic interactions which sometimes may be disastrous. https://aacc.tums.ac.ir/index.php/aacc/article/view/771