Thoraco omphalopagus type accounts for about 74% of all conjoined twins. This is the first reported case of successful separation of conjoined twins in Sri Lanka. Need of detailed preoperative assessment, multidisciplinary team approach, pre-operative meetings to collate information, formulating an agenda and developing a plan of action, organised approach to anaesthetising two individuals simultaneously and meticulous postoperative care is emphasised. Responsibility of anaesthesia team in anaesthetizing two individual patients simultaneously is highlighted.

BackgroundEvery medical practitioner has ethical, professional and legal responsibilities to respect patients' autonomy with regard to informed consent. MethodologyIntern Medical Officers (IMO) in the first 6 months of internship at the National Hospital of Sri Lanka (NHSL) were given a self-administered questionnaire designed in 2 parts to assess the practical application and theoretical knowledge of obtaining informed consent. Data was analyzed statistically using SPSS 20. Results 47.61% of IMO's had given information verbally. 100%, 97.61% and 41.86% had informed the nature, risks and alternatives respectively. 21.43% had discussed risk versus benefit. 78.57% had informed the consequences if left untreated. 83.33% had given the opportunity to clarify doubts. 51.51% of doctors who had not given all details said they did not have adequate time. 73.80% had obtained consent for elective procedures a day prior. 11.9% had used a pre-prepared consent form. 88.09% had documented. There was a statistically significant tendency of not documenting alternatives (p<0.01), risk versus benefit (p<0.01) and consequences if left untreated (p 0.032) despite providing information on them.95.23%, 85.71% and 47.61% of IMO's had correctly answered questions on capacity to consent from competent patients, children and mentally ill well controlled with treatment, respectively. No doctor was knowledgeable on obtaining consent from mentally incapacitated patients. 61.9% and 66.66% had answered correctly for obtaining consent in emergencies from competent and incompetent patients respectively. No doctor reached the required standards of 100% knowledge on capacity to consent. ConclusionThe audit revealed incomplete documentation and gaps in knowledge on obtaining consent. The need to conduct refresher programs and to introduce formal consent forms is highlighted.