ANESTHETIC MANAGEMEMT OF CRANIOPAGUS TWINS
Hammed Abd El Aziz;
Abstract
SUMMARY
hile Siamese or conjoined twins appeared early throughout history in myths and legends; the most
famous twins were Chang and Eng Bunker born in Siam in
Thailand.
The exact etiology is unknown but it may be due to incomplete cleavage of the embryo or 2ry fusion of 2 separate embryos.
Separated conjoined twins are classified according to fused body parts and their classification is important to know the feasibility of surgical separation.
Their anesthetic management started early when diagnosed antenatally and when delivery by C.S is undertaken.
The complexity of separating conjoined twins is a challenge in medical, surgical, and ethical aspects.
The ethical dilemma of conjoined twins' separation will be raised when taking consent from parents for separation and when there is a high probability to sacrifice one twin to save the other.
Emergency separation will be done when there is a congenital anomaly incompatible with life, death or impending
death of one twin, or damage to the connecting bridge. Otherwise; it is better to wait until 4-12 months of age.
The major objectives of preoperative diagnosis are to define the extent of shared organs and the degree of cross circulation.
Anesthetic management of conjoined twins involves 3 major anesthetic consideration; 1st: choice of the anesthetic teams, 2nd: clinical significance of cross circulation, finally appropriate care for each surgical procedure.
Separation of conjoined twins requires 2 anesthetic teams which are chosen according to their quality, subspecialty and ability to work in a team and to communicate with other specialities.each team is working for each twin which must be color coded and all equipments are duplicated and color coded.
Drug dosage and response to drugs is different than normal infant due to cross circulation.
Airway management of conjoined twins is also challenging especially in face to face conjoined twins; so direct laryngoscopy, flexible fiberoptic technique, vediotelescopic intubation technique, EXIT procedure or even tracheotomy may be needed.
hile Siamese or conjoined twins appeared early throughout history in myths and legends; the most
famous twins were Chang and Eng Bunker born in Siam in
Thailand.
The exact etiology is unknown but it may be due to incomplete cleavage of the embryo or 2ry fusion of 2 separate embryos.
Separated conjoined twins are classified according to fused body parts and their classification is important to know the feasibility of surgical separation.
Their anesthetic management started early when diagnosed antenatally and when delivery by C.S is undertaken.
The complexity of separating conjoined twins is a challenge in medical, surgical, and ethical aspects.
The ethical dilemma of conjoined twins' separation will be raised when taking consent from parents for separation and when there is a high probability to sacrifice one twin to save the other.
Emergency separation will be done when there is a congenital anomaly incompatible with life, death or impending
death of one twin, or damage to the connecting bridge. Otherwise; it is better to wait until 4-12 months of age.
The major objectives of preoperative diagnosis are to define the extent of shared organs and the degree of cross circulation.
Anesthetic management of conjoined twins involves 3 major anesthetic consideration; 1st: choice of the anesthetic teams, 2nd: clinical significance of cross circulation, finally appropriate care for each surgical procedure.
Separation of conjoined twins requires 2 anesthetic teams which are chosen according to their quality, subspecialty and ability to work in a team and to communicate with other specialities.each team is working for each twin which must be color coded and all equipments are duplicated and color coded.
Drug dosage and response to drugs is different than normal infant due to cross circulation.
Airway management of conjoined twins is also challenging especially in face to face conjoined twins; so direct laryngoscopy, flexible fiberoptic technique, vediotelescopic intubation technique, EXIT procedure or even tracheotomy may be needed.
Other data
| Title | ANESTHETIC MANAGEMEMT OF CRANIOPAGUS TWINS | Other Titles | المعالجه التخديريه للتوام الملتصق عن طريق الراس | Authors | Hammed Abd El Aziz | Issue Date | 2014 |
Recommend this item
Similar Items from Core Recommender Database
Items in Ain Shams Scholar are protected by copyright, with all rights reserved, unless otherwise indicated.