Background: Anterior mediastinal masses in children pose significant anesthetic challenges because of the potential for airway compression, cardiovascular compromise, and acute cardiorespiratory collapse during induction of anesthesia. Careful preoperative assessment, appropriate planning of airway and vascular access, and maintenance of spontaneous ventilation are important considerations in these patients. Case Presentation: We report the perioperative anesthetic management of a 8 years old pediatric patient with a large anterior mediastinal mass who presented for thoracotomy and surgical resection. Preoperative evaluation included clinical assessment, imaging, and evaluation for evidence of airway and cardiovascular compression. Appropriate preparation was made for difficult airway management and emergency cardiopulmonary support. Anesthesia was induced intravenously, with continuous monitoring of respiratory and cardiovascular status. After securing the airway and confirming adequate manual ventilation, there was difficulty in controlled ventilation due to compression of the airway, so the patient was immediately reversed with sugammadex and the rest of case done under spontaneous ventilation with sevoflurane with oxygen-air mixture, and thoracic epidural was placed for adequate analgesia. The mass was successfully resected through thoracotomy without major intraoperative cardiorespiratory complications. Postoperative care included close respiratory and hemodynamic monitoring, with appropriate analgesia and subsequent recovery. Conclusion: Anesthetic management of children with anterior mediastinal masses requires meticulous preoperative risk stratification and preparation for sudden airway or cardiovascular compromise. Maintaining spontaneous ventilation during the critical phase of induction, minimizing factors that can worsen airway compression, and ensuring immediate availability of advanced airway and cardiopulmonary rescue strategies are important principl