Anaesthetic managements for conjoined twins with complex cardiac anomalies
Journal
Canadian Journal of Anaesthesia
Journal Volume
43
Journal Issue
11
Pages
1161-1167
Date Issued
1996
Author(s)
Abstract
Purpose: To describe the perioperative assessment and anaesthetic management for surgical separation of three sets of conjoined twins with complex cardiac anomalies threatened with arterial desaturation and haemodynamic instability. Clinical features: Three sets of conjoined twins, one omphaloischiopagus, one omphalopagus, and one thoraco-omphalopagus, were considered for separation during the perinatal or infantile period. Preoperative functional evaluation including continuous pulse oximetry, capnography, and cardiac electrophysiological studies were considered to be as important as anatomical evaluation of the cardiac anomalies and cross-circulation by angiography in assessing the feasibility of surgical separation. Ipsilateral infusion of prostaglandin E1 and phenylephrine were applied to the cyanotic and healthy twins respectively, to restore arterial oxygenation intraoperatively and to avoid profound hypoxaemia. Conclusion: Surgical separation and anaesthesia should be well planned and rehearsed before clinical deterioration of the weaker twin. Aggressive pharmacological intervention and understanding of the cross-circulation pathophysiology is necessary to manage critical situations during surgical separation and in the postoperative period.
Subjects
Anaesthesia, paediatric; Congenital anomaly, cardiac; Twins, conjoined
SDGs
Other Subjects
article; case report; congenital heart malformation; conjoined twins; general anesthesia; human; infant; medical assessment; pathophysiology; pediatric anesthesia; postoperative period; priority journal; surgical technique
Publisher
Springer New York LLC
Type
journal article