CASE SUMMARY: A 9-month-old baby suffering from recurrent respiratory infections, barking cough, voice change, wheezing, previously admitted twice and treated as tracheaobronchiolitis presented with similar complaints was started on ionotropes and intubated for respiratory distress, sepsis with high PaCO2 and desaturation. Chest x ray showed no abnormality and ABG reveals chronic respiratory acidosis with metabolic compensation. As the respiratory parameters improved baby was extubated but post extubation baby developed respiratory distress with high PaCO2, so was reintubated but the symptoms did not subside. CT revealed a 3× 2 cm cyst between esophagus and trachea extending below the endotracheal tube end up to the level of carina causing dynamic compression and shifting of esophagus to right.

The tube was readjusted to lie below the cyst but above the carina. Baby was paralysed and ventilated until PaCO2 become normal, also avoiding endobronchial intubation due to head movements for the night and posted for thoracotomy the next day. Cyst was removed by lateral thoracotomy under general anesthesia using Sevoflurane, fentanyl and vecuronium. Intra and post op period was uneventful.

DISCUSSION: The location of the foregut duplication cyst, its mass effect, and the anatomical structures involved with the cyst may present numerous challenges for anesthesia providers. Proper understanding of the location and its effect on airway will allow us to manage the case effectively