Anesthesia for an open traumatic brain injury in a pediatric patient addresses most of all of the principles of both neuroanesthesia and pediatric anesthesia—hypovolemia, intracranial hypertension, volume of distribution, metabolic rates, hyperventilation, anesthetic inductions drugs, arterial and venous line challenges, blood transfusions, and anticonvulsant medications. The anesthesia team synchronized their actions to have an excellent outcome.