Cystic fibrosis is a rare AR disorder caused by mutation in the CFTR gene mutation regulating chloride transport in all exocrine glands producing thick secretions causing obstructive pulmonary disease,intestinal Obstruction, pancreatitis, nasal polyps which makes this disease relevant in anaesthetic management and care.

Incidence is only 1 in 30000 in asians.Only 30% present with meconium ileus and if present definitive diagnosis of CF confirmed.Three day old female child referred from outside hospital as a case of cystic fibrosis with intestinal obstruction with history of failure to pass meconium since birth,abdominal distension and vomiting.o/e baby dehydrated ,vital stable. systemswnl except abdominal distension.Routine investigations and coagulation profile normal, elevated sweat chloride levels.CXR- normal x-ray abdomen shows dilated bowel loops.

Anaesthetic management includes preop optimization of hydration status,nasogastric tube insertion to decompress stomach.Anaesthetic Plan - general anesthesia with caudal block.precautions included avoidance of preopsedation,avoidance of ketamine,minimal dose of short acting muscle relaxants,maintainence with volatile anaesthetics ,avoidance of nitrous oxide prevent further bowel distension.Intraop uneventful. Procedure lasted two hours.Inspite of all measures recovery was inadequate followingsurgery.

Postop mechanically ventilated and evaluated for causes of delayed recovery including NM monitoring ,Normothermiamaintained,.naloxone given in suspicion opioid overdosage. All investigations normal except serum calcium low corrected and baby recovered well and extubated next day.