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Deepak C, Vandana S, Pradeep B, Nikhil K. Anesthetic management of separation of conjoint twins: Challenges and limitations. Saudi J Anaesth 2019; 13:140-143. [PMID: 31007661 PMCID: PMC6448423 DOI: 10.4103/sja.sja_589_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A conjoint twin is a rare congenital anomaly. The separation of conjoint twins presents a unique challenge to anesthesiologists. We report the anesthetic management of successful separation of thoraco-omphalopagus conjoint twins, along with challenges and limitations that we faced in perioperative period. We highlight the importance of a multidisciplinary approach, proper preoperative planning, and perioperative vigilance regarding monitoring and complication.
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Affiliation(s)
- Choudhary Deepak
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sharma Vandana
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Bhatia Pradeep
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kothari Nikhil
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Abstract
Anesthetic management of the conjoined twins in the radiology suite presents some unique problems for anesthesia. We report a case of 3-month and 10-day-old xiphopagus twins undergoing computed tomography scan under general anesthesia. The issues in their management in radiology included the unknown effects of anesthetic agents on circulation because of sharing of organs, duplication of staff, equipment in a limited space, placing the children on the scan table, airway control and ventilator management, and changeover of equipment during procedure.
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Vagyannavar R, Bhattacharyya A, Misra G, Hashim M, Asmita. Craniopagus twins for magnetic resonance imaging. Saudi J Anaesth 2017; 11:509-510. [PMID: 29033747 PMCID: PMC5637443 DOI: 10.4103/sja.sja_89_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Raghavendra Vagyannavar
- Department of Anaesthesiology and Critical Care, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Amrita Bhattacharyya
- Department of Anaesthesiology and Critical Care, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Gaurav Misra
- Department of Anaesthesiology and Critical Care, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Mohammad Hashim
- Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Asmita
- Department of Senior Resident, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
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Abstract
All good intensive care requires attention to detail of the routine elements of care. These include staffing and monitoring, drug prescription and administration, feeding and fluid balance, analgesia and sedation, organ support and reducing the risk of healthcare-associated infection. Doing this well requires an understanding of the relevant physiology and an awareness of the limited evidence base. Detailed protocols and implementation checklist are valuable in ensuring that these minimum standards are met. However, peri-operative care is not all predictable and amenable to protocolization. This is especially true following separation of conjoined twins. Despite the sophisticated imaging and multi-disciplinary planning that precede elective separation, the acute physiological changes in each twin cannot always be predicted reliably. In this article, we review briefly each element of peri-operative care and how this might vary in conjoined twins.
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Affiliation(s)
- Sandra A Walsh
- Paediatric and Neonatal Intensive Care Units, Great Ormond Street Hospital, NHS Foundation Trust, Bloomsbury, London WC1N 3JH, UK.
| | - Mark J Peters
- Paediatric and Neonatal Intensive Care Units, Great Ormond Street Hospital, NHS Foundation Trust, Bloomsbury, London WC1N 3JH, UK; Critical Care Group, Respiratory, Critical Care and Anaesthesia Unit, Institute of Child Health, University College London, London, UK
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Zhong HJ, Li H, Du ZY, Huan H, Yang TD, Qi YY. Anesthetic management of conjoined twins undergoing one-stage surgical separation: A single center experience. Pak J Med Sci 2013; 29:509-13. [PMID: 24353566 PMCID: PMC3809258 DOI: 10.12669/pjms.292.3275] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 02/28/2013] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To summarize our experience in the anesthetic management of conjoined twins undergoing one-stage surgical separation. METHODOLOGY Medical records of conjoined twins admitted to our hospital for treatment and considered for surgical separation from 1996 to present were retrospectively reviewed. Four cases of conjoined twins underwent one-stage surgical separation under general anesthesia. Preoperative evaluation was performed to determine the extent of anatomical conjunction and associated anomalies. Anesthesia was simultaneously induced in all conjoined twins. The intubation procedure was successfully performed with the head slightly rotated to each baby's side, followed by the administration of vecuronium. Anesthetic agents were administered according to the estimated weight of each baby. One case of conjoined twins underwent surgical separation with cardiopulmonary bypass due to shared hearts. Results : All conjoined twins were successfully separated. No significant respiratory or cardiac events occurred during surgery except for one twin, which died after separation because of complicated congenital heart disease. Conclusions : Accurate preoperative evaluation, respiratory and circulatory management, and close cooperation of the multidisciplinary team are important aspects of anesthetic management of conjoined twins surgery.
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Affiliation(s)
- He-Jiang Zhong
- He-Jiang Zhong, MD, Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Hong Li
- Hong Li, MD, Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Zhi-Yong Du
- Zhi-Yong Du, MD, Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - He Huan
- He Huan, MD, Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Tian-De Yang
- Tian-De Yang, MD, Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Yue-Yong Qi
- Yue-Yong Qi, MD, Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
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Kiran S, Kaur KP, Rattan KNR, Rattan SK. Anaesthetic management of a patient with thoracopagus. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2010. [DOI: 10.1080/22201173.2010.10872696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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McHugh K, Kiely EM, Spitz L. Imaging of conjoined twins. Pediatr Radiol 2006; 36:899-910; quiz 1002-3. [PMID: 16622666 DOI: 10.1007/s00247-006-0121-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Accepted: 01/09/2006] [Indexed: 10/24/2022]
Abstract
The incidence of conjoined twins is estimated to be around 1 in 250,000 live births. There is a distinct female predominance. In this paper the imaging of conjoined twins both antenatally and postnatally is reviewed, in particular taking into consideration recent advances with multidetector CT. Accurate counselling of parents regarding the likely outcome of the pregnancy and the likelihood of successful separation is dependent on good prenatal imaging with ultrasound and MRI. Planning of postnatal surgical separation is aided by accurate preoperative imaging which, depending on the conjoined area, will encompass many imaging modalities, but often relies heavily on CT scanning.
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Affiliation(s)
- Kieran McHugh
- Department of Radiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.
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Abstract
BACKGROUND/PURPOSE Conjoined twins are rare and complex anomalies of the newborn. They require a highly experienced team and a center equipped to deal with such challenging anatomy. METHOD A review of 31 sets of conjoined twins was managed by one team over a 15-year period. The spectrum of the anomalies, management strategies, and outcomes will be analyzed with future recommendations. RESULTS Ten sets of complete conjoined twins and two sets of parasitic conjoined twins were successfully separated. Tissue expanders and prosthetic meshes were not required. A separation of one set of craniopagus parasiticus conjoined twins was attempted, but abandoned owing to major vascular and brain sharing. The remaining 18 sets were not separable owing to major cardiac anomalies and/or sharing, and all died within several weeks of birth. CONCLUSION Careful planning, a multidisciplinary approach, rehearsal, and experience are important factors in dealing with conjoined twins. Tissue expanders and prosthetic meshes are not required in most cases. Selective abortion or fetal intervention may play a role in the future.
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Affiliation(s)
- Abdullah Al Rabeeah
- Division of Pediatric Surgery, King Abdulaziz Medical City-Riyadh, PO Box 22490, Riyadh 11426, Kingdom of Saudi Arabia.
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Abstract
The appropriate role for laryngeal masks during delivery room resuscitation has not been established. The authors systematically reviewed the literature to answer three clinical questions: (1) In newborns requiring positive-pressure ventilation for resuscitation, would a laryngeal mask achieve safe and effective ventilation faster than facemask ventilation? (2) In newborns unable to be ventilated effectively with a facemask during resuscitation, would a laryngeal mask achieve effective ventilation faster than endotracheal intubation? (3) In newborns requiring resuscitation, would a laryngeal mask achieve effective ventilation when facemask ventilation and endotracheal intubation have been unsuccessful?
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Affiliation(s)
- Enrique Udaeta Mora
- Department of Pediatrics, Hospital Angeles Mexico, Agrarismo 208-301 B, Escandon, Mexico City 18000, Mexico
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Szmuk P, Rabb MF, Curry B, Smith KJ, Lantin-Hermoso MR, Ezri T. Anaesthetic management of thoracopagus twins with complex cyanotic heart disease for cardiac assessment: special considerations related to ventilation and cross-circulation. Br J Anaesth 2006; 96:341-5. [PMID: 16415317 DOI: 10.1093/bja/aei313] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We describe the anaesthetic management of a pair of thoracopagus twins of 14 months of age undergoing complex cardiac evaluation. Synchronous ventilation of the twins, needed for the ECG-gated magnetic resonance imaging-angiography, was achieved through a Carlens (Y) adaptor during procedures and transport. The complex logistical implications are obvious. We also describe the first use of bispectral index monitor for detection of cross-circulation in conjoint twins.
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Affiliation(s)
- P Szmuk
- Department of Anesthesiology, University of Texas Medical School at Houston, TX 77030, USA.
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Affiliation(s)
- Erik S Shank
- Department of Anesthesia and Critical Care; Massachusetts General Hospital; Boston, MA;
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