Successful separation of Xipho-Omphalopagus twins

Abstract

Xipho-omphalopagus twins are conjoined twins sharing some part of gastrointestinal system and lower sternum. These types of twins have best chances of survival if successfully separated. We report a case of successfully separated Xipho-omphalopagus twins, highlighting the importance of proper planning and team effort in such separations.

Anaesthetic management of separation of omphalopagus conjoined twins: A case report

“…It is confirmed by observing heart rate changes in second twin with atropine premedication of first twin, by observing BIS of second twin on inducing 1st twin and by using various isotope and contrast studies. 8,9 There is increased risk of hypothermia, so warm blanket, forced air warmer, warm fluid and blood, ambient OR temperature and warming OR lights should be used. 10 Survival of these patients depend on the extent of organ sharing, presence of cross circulation and presence of associated anomalies.…”

Anaesthetic challenges in conjoined twins′ separation surgery

“…[7] In the presence of cross-circulation, there is possibility of passage of drugs given to one twin to the other which may cause sedation and airway obstruction in the other and the anaesthesiologist must be aware of this possibility. [8] Regardless of the presence and degree of cross-circulation, drugs should be administered as they would be given for two separate infants. In most cases of symmetric twins, both the infants weigh almost the same; hence, it is a routine practice to take their combined weight and half it to arrive at the weight of each infant.…”

Perioperative management of separation of pygopagus conjoined twins

“…The mixing of blood leads to unpredictable drug pharmacokinetics and pharmacodynamics [9] and causes difficulties with calculation of drug dosages and fluid requirements for each twin. Unexpected responses in one twin on drug administration to the other is due to circulatory admixing [10]. Drug dosaging should be incremental and titrated to response in order to prevent cumulative and excessive drug effects.…”