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Introduction: Co-morbidities associated with Russell-Silver syndrome (RSS), viz. severe postnatal growth retardation, congenital heart disease, dysmorphic facial features, limb asymmetry, various patterns of hypogonadism, and constellation of endocrine abnormalities, present significant anesthetic challenge during surgery. We report a case of Russell-Silver syndrome in a 5½-year-old boy who underwent corrective hand surgery and the anesthetic challenges he presented. RussellSilver syndrome has an autosomal dominant inheritance pattern with variable expressivity and its diagnosis remains primarily clinical, as no definite etiology or specific tests have been established yet. We anticipated difficulty in airway management of this child and so we ensured availability of ancillary equipments and presence of skilled anesthesiologists. This helped us to conduct surgery successfully without any anesthetic complications.