Our case surrounds a 2-day-old Female with Esophageal Atresia and Tracheoesophageal Fistula (TEF) who underwent TEF repair via open thoracotomy. Mask induction was performed with high-flow sevoflurane and the patient was kept spontaneously breathing while exploratory bronchoscopy was performed. Rigid bronchoscopy confirmed the TEF to be proximal to the carina and an additional orifice, believed to be a right tracheal bronchus, was discovered. The exploratory phase of this surgery lasted two hours and presented the challenge of keeping the patient normoxic while spontaneously breathing during which secondary challenges of moving the patient, decreased EtCO2, and hypotension presented themselves and were managed accordingly.