Znieczulenie bliźniąt syjamskich — opis serii przypadków

Abstract

As any complex surgical procedure, separation of conjoined twins requires complex anesthesia management that is a prerequisite of performing the operation, while complex postoperative care is a decisive factor in the survival of the patients. The paper describes the anaesthetic management for surgical operations in ten sets of conjoined twins in the Children's Hospital of Cracow during 1977Cracow during -2005. The anaesthetic technique and associated problems are summarized.

Anesthetic management of parasitic conjoined twins' separation surgery

“…[ 1 ] The lack of prenatal information and spontaneous delivery always results in perinatal trauma in at least one of the twins worsening the surgical outcome. [ 3 ] In our case, the mother was admitted in active labor with no antenatal ultrasound record, and underwent normal vaginal delivery. Twinning was revealed at birth only, and fortunately well-formed baby escaped from the major perinatal insult.…”

“…Endotracheal intubation of thoraco-omphalopagus conjoined twins requires special positioning; we elevated one twin over another to facilitate intubation, this maneuver has been used previously also. [ 3 ] Before induction, it is necessary to check the cross-circulation so that fluid and drugs could be given accordingly. Like in our case, cross circulation was present which was assessed by clinical of effects of atropine.…”

“…Nowadays, twin surgeries are being increasingly done worldwide, but each case has its own specific difficulties requiring individualized care. [ 3 ] From anesthetist's point of view, here we are sharing our experience of a successful separation surgery underwent by a rare type of parasitic male conjoined twins who had joined hearts and common liver.…”

Anaesthetic challenges in conjoined twins′ separation surgery

“…A major concern during separation surgery is hypothermia caused by an extensive surgical wound increasing heat losses and long duration of surgery. [10] Cardiovascular collapse can occur at the point of separation which has been attributed to adrenal insufficiency. [11]…”

Anaesthesia for seperation of conjoined twins

“…Planning for post separation and rehabilitation should commence on admission. 4 Cross circulation may result in unpredictable response to anaesthetic agents. Whole body contrast CT excluded cross circulation or organ sharing in this pair.…”