The perioperative anaesthetic considerations of a child withTracheo-esophageal fistula (TOF) &complete atrioventricular block(CAVB) posted for TOF repair is presented. Children with TOF may present in the first 6months of life with repeated Respiratory tract infections andfailure to thrive. It is often associated with VACTERL anomalies& is classified as five sub types,of which H-type is rare.CAVB is seen any time after birth withcomplete atrioventricular dissociation and bradycardia and is called congenital heart block. Patients who are diagnosed and treated in childhood have a survival rate of 100%

CASE REPORT: A 3.6kg, 6month old female child with h/o repeated Respiratory tract infection and Failure to thrivewas admitted to NICU for monitoring &evaluation.TOF of H subtype suspected and child was stabilized and posted for emergency bronchoscopy tovisualize the fistula location.Accepted under ASA grade3 (E).however fistula site could not be identified and child developed bronchospasm and bradycardia, was treated and recovered well. Cardiac evaluation showed good LV function and congenital bradycardia. Child was taken up forTOF repair under ASA grade3,moderate cardiac risk under GA with Standard protocol, with Femoral vein cannulated& equipment for trans venous pacing kept ready.peri operative period was uneventful.Child needed two doses of IV atropine intraoperatively to maintain heart rate and was electively ventilated for 24 hrs. and extubated.Child iscoming for regular follow up.

Conclusion Meticulous assessment of the challenges and planning of Peri operative Anesthetic management gave a good outcome in this child.