As 8 year old boy with a tracheal cannula because of tracheal stenosia was admitted for tracheal raconstruction. The tracheal stenosis site was 2cm below the tracheal soma and 4cm above the carina. The stenotic area was 5mm in diameter and 1.5cm in length. After proper premedication, anesthesia was induced with intramuscular ketamine and maintained mainly with 0.1% ketamine intravenous drip infusion and supplemented by small amounts of muscle relaxants and N2O EKG, direct arterial pressure and arterial blood gas tensions were monitored during anesthesia. Tracheal segmental resection and reconstruction were performed without serious hypoxia and hypercarbia. Anesthetic management for possible risk during operation was discussed and the literature reviewed.