Airway Evaluation of Conjoined Twins

Abstract

Case reports in the literature on conjoined twins discuss the difficulties with anesthesia and surgical separation; however, the role of airway endoscopy as a means of evaluating the respiratory tract has not been described. This case of thoraco-omphaloischiopagus laterally conjoined twins demonstrates the importance of videoendoscopic airway evaluation in the management of conjoined twins. Direct laryngoscopy and bronchoscopy was used to evaluate ventilator dependence and demonstrated tracheal anomalies that were partially responsible for difficulties with weaning and endotracheal tube placement. Knowledge of the airway anomalies assisted in ventilator management of the twins, and the neonatalogists were able to proceed with greater confidence because no surgically correctable airway obstruction was found. Direct laryngoscopy and bronchoscopy offer valuable information about thoracopagus conjoined twins and should be included in the preoperative evaluation of planned separation of conjoined twins, as well as being used for conjoined twins who are ventilator-dependent.

Cranial conjoined twins: Surgical and anesthetic challenges for a routine procedure: Adenoidectomy and examination of ears

“…Few reports regarding airway management in conjoined twins have been published [6][7][8][9]. It is clear that the care of these complex patients requires a multidisciplinary team approach.…”

Two babies, one heart, and no airway

“…Flexible fiberoptic bronchoscopy permitted excellent diagnostic and therapeutic airway evaluation. Flexible scopes have been previously shown to help in controlled airway evaluation of conjoined twins [6]. However, SAVI is a superior tool for critical establishment of a secure airway.…”

Pediatric tracheostomy in conjoined twins: Multidisciplinary approach

“…However, little information has been published that specifically addresses pediatric tracheostomy and airway management in conjoined twins. A literature search via MEDLINE using the terms ''conjoined'', ''airway'' and ''tracheostomy'' yielded few papers with only one case report specific to tracheostomy, another specific to airway evaluation, and another to the EXIT procedure [7][8][9]. We report two institutions' experience with airway management of a set of antero-laterally joined omphalopagus twins.…”