A 6-month-old female infant was found with a heart murmur during physical examination, and cardiac ultrasound showed complete transposition of the great arteries (TGA) with ventricular septal defect (VSD) and left ventricular outflow tract (LVOT) obstruction. She was scheduled to undergo the Rastelli procedure under general anesthesia. The preoperative examination indicated a relative decrease in pulmonary blood flow. Before cardiopulmonary bypass (CPB), it is better to moderately reduce the pulmonary vascular resistance (PVR) and maintain the systemic vascular resistance (SVR) to increase the pulmonary blood flow and the blood mix of systemic and pulmonary circulation. After CPB, it is better to maintain a preload slightly below the normal range, increase the myocardial contractility, and decrease the afterload to maintain hemodynamic stability. The key point of anesthetic management in these children with TGA before CPB is adjusting the pulmonary-to-systemic pressure ratio (SVR/PVR) to balance the pulmonary cardiac output to the systemic cardiac output (Qp/Qs ratio). After CPB, the focus is on the smooth transition of the circulatory system after surgical operation.