[Anesthesia for a patient with laryngotracheoesophageal cleft]

We report anesthetic management of a patient with laryngotracheoesophageal cleft which lacks partition between the esophagus and upper airway, a rare congenital anomaly with a high mortality. A male baby weighting 2.96 kg was born at 39-week gestation. He had respiratory distress, hoarse cry and cyanosis on feeding. Gastric cardioplasty was scheduled at the age of 10 days, under the presumptive diagnosis of gastroesophageal regurgitation. Endotracheal intubation was performed and anesthesia with 1-3% sevoflurane and 100% oxygen was started. However, SpO2 dropped suddenly and transiently. Endoscopic examination performed transnasally and through the endotracheal tube demonstrated that the septum between the trachea and esophagus was absent from the larynx through the entire length of the trachea. On the basis of these finding, this case was diagnosed as laryngotracheoesophageal cleft (type 3). Esophageal division and gastrostomy were performed to prevent regurgitation and aspiration of gastric content.