Conjoined twins – the anaesthetic management of 15 sets from 1991–2002

Abstract

The Red Cross War Memorial Children's Hospital, Cape Town, South Africa is the only dedicated children's hospital in sub-Saharan Africa and, as such, is the referral hospital for complex procedures from this region. Fifteen sets of conjoined twins have presented for separation from 1991 to 2002, and a total of 34 sets since 1964. Anaesthesia for procedures on conjoined twins is a demanding, exacting and meticulous exercise, whether prior to or during separation. Anaesthesia forms part of the multidisciplinary management of the babies. Emphasis is laid on preoperative assessment, goal-directed planning of theatre and the staff involved in the surgery, duplication of all equipment necessary for anaesthetizing and monitoring two infants in one operating room, and having plans in place to avoid overcrowding. Challenges encountered in anaesthesia for these twins include identifying anatomical conjunctions, airway management, acquiring vascular access, the potential for enormous blood loss, and maintaining normothermia. Planning for the postseparation period and the reconstruction and rehabilitation of the babies is essential from the time of their initial admission. Meticulous attention to detail, monitoring and vigilance are mandatory. Successful management of conjoined twins relies on close communication and cooperation of all members of the multidisciplinary team.

Separation of Conjoined Twins in Harare, Zimbabwe: Case Report.

“…Developments have mostly been in early intrauterine diagnosis, especially using ultrasound in diagnosis of twin pregnancies and preoperative anatomical diagnosis. This enables medical management and counselling to be well planned for a suitable outcome for both family and medical team 7,12 . The surgery of separation of conjoined twins is generally complex and resource intensive.…”

Znieczulenie bliźniąt syjamskich — opis serii przypadków

“…Conjoined twins can develop a possible life-threatening condition immediately after delivery; therefore, during diagnostic and pre-separation procedures, possible emergency surgical interventions should always be considered [4][5][6][7] and emergency plans prepared. Our Institute decided to provide 24-hour duties of teams of surgeons and anaesthesiologists.…”

“…The measures applied by us to protect children did not ensure full control. The use of pre-warmed respiratory mixture proved very beneficial to maintain intraoperative normothermia [2,3,5,6].…”

“…In conjoined twins with fuse thoraxes, abdomens or heads, there is a risk of connecting the circulatory systems of both children that can be crucial during induction of general anaesthesia, particularly intravenous [5][6][7].…”

Anaesthesia – what has the University of Cape Town contributed?

“…15 Research in paediatric anaesthesia at RCWMCH in the management of conjoined twins, 16 and of the burned child, has gained international recognition. Numerous other projects are underway involving pain management, coagulation studies in burn patients, and antibiotic pharmacokinetics in children undergoing cardiac surgery.…”