Anesthetic Management of Conjoined Twins for Computed Tomography Scan

Yousuf, Muhammad Saad; Shamim, Faisal; Dogar, Samie Asghar; Khan, Fauzia Anis

doi:10.1213/xaa.0000000000000380

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…Two anesthesia machines, two anesthesia medication carts, and two patient monitors were used in one large operating theater. To avoid any confusion, color-coding is recommended [4,8]. All infusion lines, equipment, respiratory systems, and drugs were color-coded for each twin (i.e., purple for twin A and orange for twin B; see Figs.…”

Section: Discussionmentioning

confidence: 99%

Successful anesthetic management of separation surgery for pygopagus conjoined twins: a case report

et al. 2021

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Background Conjoined twins are an extremely rare congenital occurrence, and anesthetic management for surgical separation presents unique challenges for anesthesiologists. Case presentation Five-month-old male pygopagus conjoined twins underwent separation surgery. We performed anesthesia induction in the supine position and surgery in the prone position. This presented a challenge because the transition from supine to prone position reversed the positional relationship between the two babies, resulting in crossing of the respiratory circuits and monitors. To solve the problem, we used anesthesia machines and monitors on the opposite side of each baby during anesthesia induction. The positional relationship between the twins and anesthesia machines and monitors normalized after the change to the prone position. Following the separation surgery, the twins were discharged without any complications. Conclusions Our method of using opposite side anesthetic machines and monitors for anesthesia induction was useful for the safe anesthetic management of pygopagus conjoined twins.

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Section: Discussionmentioning

confidence: 99%

Successful anesthetic management of separation surgery for pygopagus conjoined twins: a case report

et al. 2021

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“…Premature conjoined twins with anal atresia may have some problems in airway management, lung ventilation and positioning during surgery (1). In our literature search, we did not encounter any procedure before the surgical separation and UG-CVC insertion under general anaesthesia without an IV access.…”

Section: Discussionmentioning

confidence: 99%

Anaesthesia Management of Premature Conjoined Twins with Anal Atresia

Hatipoğlu

Özden

Bahçeci

et al. 2019

Turk J Anaesthesiol Reanim

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Introduction Conjoined twins have multiple congenital anomalies, as well as anatomic fusions; therefore, they also need various surgical procedures and invasive interventions beyond the separation process. We present the anaesthetic management during the colostomy opening in omphalopagus twins and ultrasound-guided (UG) central venous catheterisation (CVC). Case Presentations Case 1 Conjoined twins (both males) were delivered by an emergency caesarean section under general anaesthesia at 34 weeks of gestation. The twins, named as B1 and B2 (Figure 1), had a total weight of 3,620 grams. Ultrasonography revealed single rectum and one set of male genitalia. The transthoracic echocardiogram finding of B1 was normal; however, B2 had patent foramen ovale. On day 6, the twins were taken into the operating room after written informed consent was obtained from parents. The anaesthesia of twins was performed by two teams. They were monitored with electrocardiogram, non-invasive blood pressure and peripheral oxygen saturation. For fluid resuscitation, 5% Dextrose-0.02% NaCl was initiated. Anaesthesia induction for B1 was provided with incremental concentrations of sevoflurane in 100% oxygen (O2). Simultaneously, the ventilation of B2 was provided with 2% sevoflurane. Firstly, B1 was intubated after rocuronium (0.6 mg kg −1) administration, and then the intubation of B2 was attempted; however, he showed excessive movement during intubation. Therefore, rocuronium was also applied to B2, and intubation was successful. A size 2.5 uncuffed endotracheal tube was used, and pressure-controlled ventilation was preferred to adjust the end-tidal carbon dioxide values between 30 and 35 mmHg of both twins. The body temperatures were 35°C and 34.8°C, respectively, at the beginning of surgery. Anaesthesia was continued with 0.2%-1% sevoflurane in 50% nitrous oxide (N 2 O)-O 2 mixture, and additional rocuronium was administered when needed. Cystoscopy and opening of colostomy were conducted. Haemodynamic and respiratory parameters were within normal physiologic limits during anaesthe

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“…One advantage was that the twins had undergone general anaesthesia for radiological assessment at our institution two weeks earlier. We have previously reported the issues of anaesthetising and managing these babies in a radiological suite prior to surgery [3].…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management of thoraco‐omphalopagus twins with congenital heart disease for separation surgery

Dogar¹,

Hamid²,

Khan

et al. 2017

Anaesthesia Cases

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Summary Conjoined twins' separation surgery poses challenges to anaesthetists due to the variable degree of cross circulation, difficulty in positioning, bleeding and limitations of space for sharing between two anaesthetic teams. We present the anaesthetic management for separation surgery of three‐months old conjoined twins. Both babies had congenital heart disease, with one baby hypertensive and commenced on enalpril pre‐operatively. A pre‐operative multi‐disciplinary meeting between all stake holders and a full environment simulation was performed and was helpful. The problems encountered included difficulty in percutaneous central venous line placement requiring surgical cut down and intra‐operative bleeding requiring vasopressor therapy and postoperative intensive care unit stay.

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Anesthetic Management of Conjoined Twins for Computed Tomography Scan

Cited by 4 publications

References 8 publications

Successful anesthetic management of separation surgery for pygopagus conjoined twins: a case report

Successful anesthetic management of separation surgery for pygopagus conjoined twins: a case report

Anaesthesia Management of Premature Conjoined Twins with Anal Atresia

Anaesthetic management of thoraco‐omphalopagus twins with congenital heart disease for separation surgery

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