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

Kozak, Frederick K.; Fandiño, Marcela; Carpes, Luthiana F.; Peiris, Kawshala; Malherbe, Stephan; Purdy, Robert H.

doi:10.1016/j.ijporl.2010.12.019

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…However, there are case reports of conjoined twins undergoing an anesthetic where a crossover trial was done, and during subsequent anesthesia administration, the opposite effect occurred. 6 This variability in effect also has occurred in the past with our patients. For this reason, we did not want to sedate either twin during our procedure.…”

Section: Discussionsupporting

confidence: 77%

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Supraclavicular Block as a Sole Anesthetic Technique in Craniopagus Twins

Schleelein

Perate

Ganesh

2013

Regional Anesthesia and Pain Medicine

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This is the first report in the literature of a sole regional anesthetic for adult craniopagus twins using a supraclavicular block for an elbow incision and drainage/bursa excision procedure. It demonstrates that for these complex medical patients, a total regional anesthesia technique is preferable when possible. There are several known general anesthetic complications in these patients. Anesthetic crossover between the twins can occur and may be variable; furthermore, the incidence and severity of the crossover effects of different anesthetics vary. Positioning of the twins can be difficult with both regional and general anesthesia. However, with regional anesthesia, the twins can position themselves and report any discomfort, which could go unnoticed under general anesthesia, leading to other complications. Craniopagus twins have a high likelihood of a difficult airway due to anatomy or positioning difficulties, which is avoided by regional anesthesia. This case emphasizes the unique challenges that these patients pose and the ability of regional anesthesia to help avoid the pitfalls of general anesthesia in these patients.

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Section: Discussionsupporting

confidence: 77%

“…Conjoined twining has an approximate incidence of 10 to 20 per million births in the United States. 6 Craniopagus is the rarest of the types of conjoined twins, with an overall occurrence of 0.6 per million births. 7 This type represents only 2% to 6% of all conjoined twins.…”

Section: Discussionmentioning

confidence: 99%