Anesthetic Management for Separation Surgery of Omphalopagus Conjoined Twins
Islam Mohammad Shehata;
Abstract
While 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 secondary fusion of two separate embryos.
S conjoined twins are classified according to fused body parts. Omphalopagus: joined face-to-face primarily in the area of the umbilicus, and sometimes involving the lower thorax, but always preserving two distinct heart, two pelvis, four arms and four legs and this increase the feasibility of surgical separation.
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 4months to 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, even tracheotomy may be needed.
Successful separation is expected to increase and if we can improve our knowledge and practice; more achievements will be declared.
The exact etiology is unknown but it may be due to incomplete cleavage of the embryo or secondary fusion of two separate embryos.
S conjoined twins are classified according to fused body parts. Omphalopagus: joined face-to-face primarily in the area of the umbilicus, and sometimes involving the lower thorax, but always preserving two distinct heart, two pelvis, four arms and four legs and this increase the feasibility of surgical separation.
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 4months to 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, even tracheotomy may be needed.
Successful separation is expected to increase and if we can improve our knowledge and practice; more achievements will be declared.
Other data
| Title | Anesthetic Management for Separation Surgery of Omphalopagus Conjoined Twins | Other Titles | التدابير التخديرية لجراحات فصل التوائم الملتصقة سريا | Authors | Islam Mohammad Shehata | Issue Date | 2014 |
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