RESUMO
@#Esophageal atresia (EA) is one of congenital anomaly which needs early surgical intervention in most cases. The needs of early referral to tertiary healthcare in developing countries like Indonesia may be an issue. Airway management, adequate ventilation and concomitant comorbidities are serious challenges for the anesthesiologist. We reported a case of a 31 days old infant diagnosed as esophageal atresia and fistula in the tracheoesophageal with bilateral pneumonia and early onset of sepsis. Delayed of referral due to limited access to tertiary hospital. Preoperative optimization and stabilization to deal with respiratory problems and inadequate nutrition has done before the definitive surgery. Airway management to ensure adequate ventilation done by careful endotracheal placement. Thoracic epidural catheter was inserted to deliver adequate analgesia and reduce opioid requirements. We transferred the patient to the neonatal intensive care unit following 3 hours of uneventful surgery.