Anaesthetic challenges in conjoined twins′ separation surgery

Abstract

Conjoined twins are a rare congenital anomaly of unknown aetiology. We report the successful anaesthetic management of separation of ischiopagus tetrapus conjoined twins. The importance of a multidisciplinary approach, thorough pre-operative evaluation and planning, vigilant monitoring and anticipation of complications such as massive blood and fluid loss, haemodynamic instability, hypothermia and intensive, post-operative care are emphasised.

Anesthetic management of parasitic conjoined twins' separation surgery

“…Blood products should be prearranged anticipating massive blood loss. [ 5 8 ] Fortunately, in our case, blood loss was minimal requiring 50 ml of packed cell.…”

“…Separation surgery in twins requires meticulous intra-operative monitoring. [ 8 ] In our case, intra-arterial blood pressure monitoring helped us in timely detection and management of hemodynamic instability during traction over the heart and liver. Similarly, temperature should be monitored regularly to prevent hypothermia, especially in prolonged surgeries.…”

“…Like in our case, cross circulation was present which was assessed by clinical of effects of atropine. [ 8 ]…”

Conjoined twins: A report of four cases

“…Ventral parasites are supplied by the vessels of the falciform ligament, intercostal arteries, mesenteric arteries, epigastric arteries, left subclavian artery, and brachiocephalic trunk [ 9 ]. Omphalocele was reported in approximately half of epigastric heteropagus, but major omphalocele was seen only in a few cases [ 10 , 11 ].…”

“…[ 8 ]. In almost all cases, antenatal ultrasound can detect the presence of conjoined twins as early as 12 weeks of gestation [ 9 ].…”