A case is presented of acute respiratory distress resulting from pneumothorax, pneumome-diastinum, pneumoperitoneum and subcutaneous emphysema in a 9 year old female patient having sugery for a cleft palate. This complieation was thought to have been due to inattentive positive pressure ventilation during anesthesia. Bilatera closed thoracotomy was performed in the recovery room. This patient recovered without any other problem.