Backgrond: Achalasia is a motor disorder. Increasing number of esophegectomy for megaesophagus and recurrent symptoms with prior esophagotomy/ballondialataion has drawn the interest of anesthetist as the procedure being distinctive and technically demanding operation.The aim of the present paper is to report the anesthesia administered to the patient who was planned for transhaitalesophgectomy.

Method:Under GA+ epidural anesthesia. Patient was adequately premedicated for reflux. CVP line secured. Thoracic epidural was put at T9-TI0.Aspiration is major concern. Therefore it was productive to do rapid sequence intubation. Secured airway with cuffed endotracheal tube with gel lubrication on the tracheal cuff to reduce pulmonary aspiration. Continuous aspiration of nasogastric tube and proximal trachea was done.Anestheisa was maintained with O2 and intermittent vecuronium.At the end epidural analgesia was given and shifted to ICU for elective ventilation.

Result: Patient was hemodynamically stable at the end of surgery. Carefully intraoperative BP and cardiac rhythm was monitored during mediastinal approach. Thorasic epidural provided satisfactory analgesia to reduce the surgical stress response, allowing deep breathing and effective coughing, there by reducing atelectasis.Earlyentral nutrition helped maintain integrity of intestinal mucosa preventing translocation of bacteria and reduce sepsis.

Conclusion: Esophagectomy is associated with high mortality and morbidity. Anaesthesiologist must be prepared and trained to distinctive details that surrounds the perioperative care of esophagectomy patients.Communication between surgeon and anaesthesiologist during mediastinaldissection,carefull fluid monitoring with CVP, timely thoracic epidural analgesia and early extubationhelps in better outcome.