Patients with tracheoesophageal fistula (TEF) usually undergo surgery through rigid bronchoscopy. As anesthesiologists and surgeons frequently share the airway, management of intraoperative ventilation and oxygenation becomes a major challenge. In the present report, the TEF patient underwent ultrasound atomized inhalation superficial anesthesia, ultrasound‑guided bilateral superior laryngeal nerve block, while tracheal stent replacement was performed by rigid bronchoscopy under intravenous general anesthesia with spontaneous breathing and supported with veno‑venous extracorporeal membrane oxygenation. The patient had good intraoperative oxygenation, and the whole operation was completed smoothly. The patient was successfully discharged.