Adventist Development and Relief Agency (ADRA) Japan, a non governmental organization (NGO), following an official request of Federal Democratic Republic of Nepal Government has organized Nepal Cleft Lip and Palate Surgery Project since 1995. We participated in the 14th Project as one of the anesthesiologists from 7th to 22nd November 2009 and performed general anesthesia with a Nepalese anesthetist without a medical license in Sheer Memorial Hospital. Use of unfamiliar anesthetic medications and limited medical devices made us understand the difficulty of anesthetic management. This valuable anesthetic experience will be useful for us in general anesthetic management in the future.