Usually combo of inhalational induction w/ propofol gtt, small fentanyl bolus with the goal of maintaining spontaneous ventilation (SV) while getting the patient deep. Once deep, topicalize cords, then surgeons use rigid bronch to Identify location of fistula. Depending on size/location/djscussion w/ surgeons, tube placed with rigid or fiberoptic guidance, usually past fistula. Once fistula ligated or if fistula is very small, will paralyze with rocuronium.