Anesthetic management of conjoined twins undergoing one-stage surgical separation: A single center experience

Abstract

Objective: To summarize our experience in the anesthetic management of conjoined twins undergoing one-stage surgical separation. Methodology: Medical records of conjoined twins admitted to our hospital for treatment and considered for surgical separation from 1996 to present were retrospectively reviewed. Four cases of conjoined twins underwent one-stage surgical separation under general anesthesia. Preoperative evaluation was performed to determine the extent of anatomical conjunction and associated anomalies. Anesthesia was simultaneously induced in all conjoined twins. The intubation procedure was successfully performed with the head slightly rotated to each baby’s side, followed by the administration of vecuronium. Anesthetic agents were administered according to the estimated weight of each baby. One case of conjoined twins underwent surgical separation with cardiopulmonary bypass due to shared hearts. Results: All conjoined twins were successfully separated. No significant respiratory or cardiac events occurred during surgery except for one twin, which died after separation because of complicated congenital heart disease. Conclusions : Accurate preoperative evaluation, respiratory and circulatory management, and close cooperation of the multidisciplinary team are important aspects of anesthetic management of conjoined twins surgery.

Advanced 3D “Modeling” and “Printing” for the Surgical Planning of a Successful Case of Thoraco-Omphalopagus Conjoined Twins Separation

“…The surgical time for the separation of the twins was 4 h and 57 min, about 3 h less than other similar cases reported in the literature (Saranrittichai et al, 2007;Bugaje et al, 2010). There were no intra and postoperative complications such as bleeding and need for transfusions unlike similar clinical cases described in the literature (Zhong et al, 2013), no blood transfusions were required. Post-surgery intubation times were 10 days and thoracic-abdominal drainages were removed after 5 days from surgery.…”

Anaesthetic management of separation of omphalopagus conjoined twins: A case report

“…Induction of anaesthesia should depend on several factors like presence of intravenous access, difficulty in airway due to difficult positioning or presence of associated anomalies, haemodynamic stability and preference of anaesthesiologist. 7 The presence of cross circulation place an important role. It is confirmed by observing heart rate changes in second twin with atropine premedication of first twin, by observing BIS of second twin on inducing 1st twin and by using various isotope and contrast studies.…”

Anaesthetic challenges in conjoined twins′ separation surgery

“…Anomalies of the airway and peculiar positioning can pose significant challenges during intubation. [9]…”