To highlight intraoperative and postoperative challenges in patient withesophageal atresia or stricture undergoing oesophageal replacement surgery. We report two such cases and important considerations in its management.

First case- 4year child, weighing 16kgs, with history of corrosive ingestion 1year back, which lead to development of stricture. He was planned for jejunal transposition.

11month infant, weighing 8 kgs. He had oesophageal atresia and oesophagostomy and gastrostomy was done on 2ndday of life. Gastric pullup surgery was planned. In preanesthetic examination no associated congenital anomaly present. We planned for general anesthesia along with lumbar epidural for intraoperative and postoperative analgesia. Proper oropharyngeal suction done. After premedication with midazolam and glycopyrrolate, fentanyl 2μg/kg given. Thiopentone and succinylcholine were used for induction. After endotracheal intubation, lumbar epidural given in L3-L4 intervertebral space and 0.2% ropivacaine 0.5 ml/kg bolus given followed by epidural catheter insertion. Intraoperatively hypotension occurred in first case but managed successfully with blood transfusion and vasopressors. Postoperatively both patients shifted intubated to ICU for elective ventilation and kept sedated with midazolam 2μg/kg/min. Analgesia was maintained with epidural 0.2% ropivacaine combined with 0.5μg/kg dexmedetomidine 6 hourly. Both were extubated on 2nd and 3rd postoperative day CONCLUSION : Oesophageal replacement surgery is challenging case for anaesthesiologists in various perspects including risk for major blood loss, requirement for adequate intraoperative and postoperative analgesia, pediatric patient and need for postoperative elective ventilation and adequate sedation. Cautious management is required in all these aspects for a favourable patient outcome.