Background: Tracheoesophageal fistula (TEF) is a congenital anomaly occurring in approximately 1 in 3,500 live births, often associated with other congenital malformations under the VATER/VACTERL association. TEF management, especially the anesthetic approach for surgical repair, is complex, requiring tailored strategies to ensure neonatal safety and successful outcomes. Methods: This prospective case series was conducted at a tertiary care institute, involving 11 neonates diagnosed with TEF. The study excluded neonates on ventilator support and those with co-morbid conditions. Anesthetic management combined general anesthesia with caudal epidural analgesia. Baseline vitals were recorded, and neonates were premedicated with glycopyrrolate, fentanyl, midazolam, ondansetron, and hydrocortisone. General anesthesia was induced with sevoflurane, and a Portex uncuffed endotracheal tube was used for intubation. A caudal epidural catheter was inserted and advanced to the T5-T6 level, administering bupivacaine for analgesia Results: Intraoperative and postoperative monitoring of heart rate, SpO2, and respiratory rate indicated effective stabilization and pain management. The mean heart rate decreased significantly over time, with stable SpO2 levels postoperatively, demonstrating the effectiveness of the combined anesthetic approach. One neonate succumbed to sepsis postoperatively, while the remaining ten neonates recovered with early extubation. Conclusion: The combination of general anesthesia with caudal epidural analgesia provided effective pain management and physiological stability in neonates undergoing TEF repair. This approach may reduce opioid requirements, facilitate early recovery, and minimize postoperative complications, making it a viable option for managing neonates with this complex congenital condition.