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Anaesthesia for the separation of conjoined twins.

Lalwani J, Dubey K, Shah P - Indian J Anaesth (2011)

Bottom Line: Thoraco-omphalopagus is one of the most common type of conjoint twins accounting for 74% cases of conjoint twins.We report the anaesthetic management for successful separation of thoraco-omphalopagus conjoint twins, both of them surviving till date.Detailed description of successful management is reported.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology and Critical Care, PT.J.N.M. Medical College and Dr. Bram Hospital, Raipur, Chhattisgarh, India.

ABSTRACT
Thoraco-omphalopagus is one of the most common type of conjoint twins accounting for 74% cases of conjoint twins. We report the anaesthetic management for successful separation of thoraco-omphalopagus conjoint twins, both of them surviving till date. We highlight the responsibility of anaesthesia team in anaesthetising the two individual patients simultaneously, need of careful monitoring and anticipation of complications like massive blood loss, hypotension, hypokalemia, hypoxia and hypercabia. Detailed description of successful management is reported.

No MeSH data available.


Related in: MedlinePlus

Twins after intubation
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Figure 0003: Twins after intubation

Mentions: A full rehearsal of the parts to be played by each member of the anaesthesia team was carried out on the day before operation. The twins were placed on warm gamgee on the operation theatre (OT) table. ECG, non-invasive blood pressure, pulse oximeter, temperature, end tidal CO2 andurine output monitoring were attached separately to both the babies. In order to prevent confusion, all the monitoring cables and i.v. lines were colour-coded (red for R1and blue for R2). Separate peripheral i.v. lines were secured in OT and then both the babies were premedicated simultaneously with i.v. atropine 0.15, fentanyl 10 μg and midazolam 0.5 mg. After preoxygenation with Jackson Rees modification of the Ayre’s T-piece, the babies were induced separately with inj. thiopentone sodium and paralysis achieved with suxamethonium. Orotracheal intubation with no.4.0 mm plain orotracheal tube of both babies was done. Intubation was not difficult, although the position was not an ideal one because of the junction at the chest. After fixation of the tubes each twin was given 4 mg of atracurium besylate intravenously and their lungs ventilated manually with 50% oxygen and 50% nitrous oxide and low concentration (0.5%) of isoflurane [Figure 3]. Central venous cannulation was done through the right femoral vein via Seldinger technique in both babies. It provided a secure i.v. line for both intraoperative and postoperative periods besides central venous pressure (CVP) measurements.


Anaesthesia for the separation of conjoined twins.

Lalwani J, Dubey K, Shah P - Indian J Anaesth (2011)

Twins after intubation
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3106394&req=5

Figure 0003: Twins after intubation
Mentions: A full rehearsal of the parts to be played by each member of the anaesthesia team was carried out on the day before operation. The twins were placed on warm gamgee on the operation theatre (OT) table. ECG, non-invasive blood pressure, pulse oximeter, temperature, end tidal CO2 andurine output monitoring were attached separately to both the babies. In order to prevent confusion, all the monitoring cables and i.v. lines were colour-coded (red for R1and blue for R2). Separate peripheral i.v. lines were secured in OT and then both the babies were premedicated simultaneously with i.v. atropine 0.15, fentanyl 10 μg and midazolam 0.5 mg. After preoxygenation with Jackson Rees modification of the Ayre’s T-piece, the babies were induced separately with inj. thiopentone sodium and paralysis achieved with suxamethonium. Orotracheal intubation with no.4.0 mm plain orotracheal tube of both babies was done. Intubation was not difficult, although the position was not an ideal one because of the junction at the chest. After fixation of the tubes each twin was given 4 mg of atracurium besylate intravenously and their lungs ventilated manually with 50% oxygen and 50% nitrous oxide and low concentration (0.5%) of isoflurane [Figure 3]. Central venous cannulation was done through the right femoral vein via Seldinger technique in both babies. It provided a secure i.v. line for both intraoperative and postoperative periods besides central venous pressure (CVP) measurements.

Bottom Line: Thoraco-omphalopagus is one of the most common type of conjoint twins accounting for 74% cases of conjoint twins.We report the anaesthetic management for successful separation of thoraco-omphalopagus conjoint twins, both of them surviving till date.Detailed description of successful management is reported.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology and Critical Care, PT.J.N.M. Medical College and Dr. Bram Hospital, Raipur, Chhattisgarh, India.

ABSTRACT
Thoraco-omphalopagus is one of the most common type of conjoint twins accounting for 74% cases of conjoint twins. We report the anaesthetic management for successful separation of thoraco-omphalopagus conjoint twins, both of them surviving till date. We highlight the responsibility of anaesthesia team in anaesthetising the two individual patients simultaneously, need of careful monitoring and anticipation of complications like massive blood loss, hypotension, hypokalemia, hypoxia and hypercabia. Detailed description of successful management is reported.

No MeSH data available.


Related in: MedlinePlus