The multiple anesthetic challenges associated with tracheoesophageal fistula surgery are difficult tracheal intubation, continuous air leakage during positive pressure ventilation, gastric distension, sharing of the airway with surgeons, intraoperative desaturation due to surgical retractors and maintaining anesthetic depth. These challenges are managed properly only when pathophysiology of the fistula is well understood. In this case report we present an anesthetic management with a near miss situation during repair of tracheoesophageal fistula. Intraoperatively, desaturation occurred which did not increase despite correcting all possible reasons. Before the worst could have occurred, we identified endotracheal tube blockage and changing the tube on time saved the neonate.
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