Among the very little published literature, none have discussed care in a neonate regarding anesthetic risk and management of the neonate with congenital bronchobiliary fistula during thoracoscopy and thoracotomy. A recent study analyzed related risk factors and literature review from perioperative ventilation, circulation and other aspects of management.Case presentationA neonate with a diagnosis of congenital bronchobiliary fistula conjoined with severe chemical pneumonia, consolidation of the lungs, and infection was encountering the risk of anesthesia under thoracoscopy exploration surgery. The neonate also underwent more than 20 days of a diagnostic period before operation. Many risk factors switched the patient from minimally invasive surgery to thoracotomy, involving persistent hypoxemia, hypercapnia, difficult surgical exposure and the severe difficulty of intraoperative ventilation management. Anesthesia maintenance after conversion to open access stayed problematic. Fortunately, after 4 months of follow-up, the patient did not have any sign of any adverse CNS effects.Thus, hypoxemia, increased airway resistance, impaired ventilation, and the risk of metabolic acidosis can be regarded to be the most prominent anesthesia challenges. Close cooperation among the entire neonatal medical team derived success in managing this rare case.SOURCE- Yin H, Zhao G, Du Y. et al. Anesthesia management in neonatal congenital bronchobiliary fistula: case report and literature review. BMC Anesthesiol 2020; 20. https://doi.org/10.1186/s12871-020-01052-4