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
ABSTRACT
Scleroderma is a multisystem disease that starts with the inflammation and atrophy of small blood vessels and leads to fibrosis of the skin and visceral organs. The pathological effects of the disease on various organ systems significantly impact aspects of anesthetic management. In this article, we describe the general anesthetic management of a scleroderma patient undergoing tricuspid valve replacement under cardiopulmonary bypass. We also review for the anesthesiologist perioperative considerations particular to this disease, especially the selection of anesthetic type, method of tracheal intubation, and establishment of venous access. The management of pulmonary hypertension and other anesthesia-related complications during the perioperative period are also discussed.