Tracheal agenesis

Tracheal agenesis is a rare, congenital anomaly that may present to the anaesthesiologist in the operating room or in the delivery suite [1]. It was first reported by Payne in 1900 [2]. Since then, more than 150 cases worldwide have been reported in literature [3,4]. The incidence is 1/50,000 births, male: female ratio is 2:1 [3]. Several types have been described in literature. It usually manifests in the new born with severe respiratory distress and an absent cry [5]. There is failure to perform endotracheal intubation. Ventilation via a bagvalve-mask and oesophageal intubation (i.e. only in the presence of a trachea-oesophageal fistula) may enable supportive ventilation until a complete evaluation is made. Further, the airway management of laryngeal agenesis and tracheal agenesis at birth, in the delivery room differs significantly [1]. Embryologically, during the 3rd and 4th week of gestation, the oesophagus and trachea begin their development. Ventral displacement of the trachea-oesophageal septum at this stage causes the tracheal agenesis. Various anomalies of the larynx or trachea or both may develop [3].