This review article addresses the anesthetic management of patients with Edwards Syndrome (Trisomy 18) undergoing extensive spinal surgery. Edwards Syndrome is a genetic disorder characterized by multiple congenital anomalies, including cardiovascular defects, respiratory issues, and musculoskeletal deformities, posing significant challenges in perioperative care. Key considerations include a comprehensive preoperative evaluation focusing on cardiovascular and respiratory assessments, such as echocardiography and pulmonary function tests. Intraoperative management requires advanced monitoring to maintain hemodynamic stability and tailored anesthetic techniques to ensure adequate ventilation and fluid balance. Multimodal analgesia strategies are essential for adequate pain control while minimizing respiratory depression. Postoperative care involves close monitoring in an intensive care setting to manage potential complications. The article emphasizes the importance of a multidisciplinary approach, integrating the expertise of anesthesiologists, cardiologists, pulmonologists, and surgeons to address the complex needs of these patients and achieve optimal surgical outcomes.