[Case of trachea agenesis managed with esophageal intubation]

A male neonate was born after 39 weeks of gestation by normal vaginal delivery. The pregnancy was uneventful. He developed immediate respiratory distress at birth with an Apgar score of 4 and 5 at 1 and 5 minutes, respectively. He was initially resuscitated with bag-mask ventilation, and subsequently transferred to the neonatal intensive care unit. Oral tracheal intubation was attempted in the NICU with no success and finally he was barely ventilated after esophageal intubation. Neonatologists consulted with an otolaryngologist for emergency tracheostomy. After our preanesthesia evaluation, we pointed out the possibility of trachea agenesis and requested surgeon for distal esophageal banding with gastrostomy to stabilize mechanical ventilation. General anesthesia was induced and maintained with sevoflurane in oxygen-air mixture supplemented with continuous infusion of fentanyl. His respiratory condition improved when distal esophageal banding and gastrostomy were completed. Esophageal endoscopy and CT scan were performed postoperatively and their findings revealed Floyd's type II tracheal agenesis in which tracheostomy was impossible. In this case, not enforcing tracheostomy proved to be a turning point in respiratory management.