Anaesthetic managements for conjoined twins with complex cardiac anomalies.
نویسندگان
چکیده
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.
منابع مشابه
Successful Surgical Separation of Thoraco-Omphalopagus Symmetrical Conjoined Twins in Iran: Two Case Reports
Conjoined twins are derived from the division of a single fertilized ovum; a phenomenon accompanied with multiple congenital anomalies. Such twins are identical, of the same sex, and more likely to be female. Most twins die during the embryonic period, and only 18% survive longer than 24 hours. There are complex anomalies in thoraco-omphalopagus twins that makes them unlikely to live long enoug...
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ورودعنوان ژورنال:
- Canadian journal of anaesthesia = Journal canadien d'anesthesie
دوره 43 11 شماره
صفحات -
تاریخ انتشار 1996