Since the 1960s neonatal intensive care therapy made great progress. Along with the new possibilities of treatment unknown complications occurred especially in the upper respiratory tract. To relieve these respiratory complications new surgical techniques were developed in the 1980s. Children that were successfully operated on may now present to an anesthetist as a teenager or young adult. The serious anatomic deviations may cause unexpected problems during the induction of anesthesia. This casuistry will show a possible algorithm that may keep patient and physician save from difficulties and surprises.