Perioperative management of anterior mediastinal mass may be difficult to manage for anesthesiologists as well as thoracic surgeons. General anesthesia is preferred approach for such surgeries, but there is the risk of compression of the trachea after induction. A more physiological and less invasive method is thoracic epidural anesthesia without endotracheal intubation. An anterior mediastinal mass was excised successfully in the fully awake patient under high thoracic epidural block in a tertiary care institute. This approach may be replicated further in the management of patients with compromised pulmonary reserve with a reduction of length of stay in intensive care unit and hospital.