CASE REPORT
Year : 2020  |  Volume : 14  |  Issue : 1  |  Page : 100-103

Our experience with anesthetic management of conjoined twins' separation surgery


1 Department of Anesthesiology, Institute of Medical Sciences-Banaras Hindu University (IMS-BHU), Varanasi, Uttar Pradesh, India
2 Department of Paediatric Surgery, Institute of Medical Sciences-Banaras Hindu University (IMS-BHU), Varanasi, Uttar Pradesh, India

Correspondence Address:
Dr. Richa Rai
Department of Anaesthesiology, Sir Sunderlal Hospital, Institute of Medical Sciences-Banaras Hindu University (IMS-BHU), Varanasi, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sja.SJA_142_19

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Conjoined twins are one of the most fascinating human malformations. Here, we report the anesthetic management and challenges faced in performing the successful separation surgery of 4-day-old thoraco-omphalopagus conjoined twins, born at term to a multigravida by elective caesarean section weighing 3.5 kg with APGAR score of more than 7. Computerized tomography scan revealed fused anterior surface of the left lobe of liver with common left portal vein. Confirmation of cross-circulation between the twins was done by giving intravenous midazolam to one of the conjoined twins, but no effect seen in the other one. We highlighted the responsibility of anesthesia team in anesthetizing sequentially the two patients who are joined together, technical difficulty of intubating the twins facing each other, need of careful monitoring, anticipation of complications such as massive blood loss, hemodynamic instability, desaturation, and hypothermia, and preparedness for their management and vigilant postoperative care.


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