Abstract Fractured carbonate reservoirs are susceptible to blowout and lost circulation during drilling, which not only restricts drilling speed, but also poses big threat to well control. Moreover, there are few technical means available to reconstruct pressure balance in the borehole. Accordingly, the fine managed pressure drilling was used in the drilling of Well GS19 in the Qixia Formation with super-high pressure and narrow density window, which is a success: ① back pressure in the annular spaces will be adjusted to maintain a slightly over-balanced bottom-hole hydraulic pressure, and fluid level in the circulation tank will be kept in a slight dropping state to ensure that natural gas in the formation would not invade into the borehole in a massive volume; ② inlet drilling fluid density will be controlled at around 2.35 g/cm 3 , back pressures in the annular be maintained at 2–5 MPa, and bottom-hole pressure equivalent circulation density be controlled at 2.46–2.52 g/cm 3 ; ③ during managed pressure drilling operations, if wellhead pressure exceeds or expects to exceed 7 MPa, semi-blind rams will be closed. Fluids will pass through the choke manifold of the rig to the choke manifold specifically for pressure control before entering gas/liquid separators to discharge gas; ④ during tripping back pressure will be kept at less than 5 MPa, volume of injected drilling fluid will be higher than the theoretical volume during tripping out, whereas the volume of returned drilling fluid will be higher than the theoretical volume during the out-tripping. This technique has been applied successfully in the drilling of the Qixia Formation, Liangshan Formation and Longmaxi Formation with a total footage of 216.60 m, as a good attempt in complicated wells with both blowout and lost circulation risks, which can provide valuable experiences and guidance for handling similar complexities in the future.