Rawat Amber, Rai Richa, Paswan Anil K, Pandey Vaibhav
Department of Anesthesiology, Institute of Medical Sciences-Banaras Hindu University (IMS-BHU), Varanasi, Uttar Pradesh, India.
Department of Paediatric Surgery, Institute of Medical Sciences-Banaras Hindu University (IMS-BHU), Varanasi, Uttar Pradesh, India.
Saudi J Anaesth. 2020 Jan-Mar;14(1):100-103. doi: 10.4103/sja.SJA_142_19. Epub 2020 Jan 6.
Conjoined twins are one of the most fascinating human malformations. Here, we report the anesthetic management and challenges faced in performing the successful separation surgery of 4-day-old thoraco-omphalopagus conjoined twins, born at term to a multigravida by elective caesarean section weighing 3.5 kg with APGAR score of more than 7. Computerized tomography scan revealed fused anterior surface of the left lobe of liver with common left portal vein. Confirmation of cross-circulation between the twins was done by giving intravenous midazolam to one of the conjoined twins, but no effect seen in the other one. We highlighted the responsibility of anesthesia team in anesthetizing sequentially the two patients who are joined together, technical difficulty of intubating the twins facing each other, need of careful monitoring, anticipation of complications such as massive blood loss, hemodynamic instability, desaturation, and hypothermia, and preparedness for their management and vigilant postoperative care.
联体双胎是最引人入胜的人类畸形之一。在此，我们报告一对4天大的胸腹联体双胎成功分离手术的麻醉管理及面临的挑战。这对双胎为足月出生，经选择性剖宫产出生于一位经产妇，体重3.5千克，阿氏评分超过7分。计算机断层扫描显示肝脏左叶前表面融合且有共同的左门静脉。通过给其中一个联体双胎静脉注射咪达唑仑来确认双胎之间的交叉循环，但在另一个双胎身上未见效果。我们强调了麻醉团队在依次麻醉这两个相连患者时的责任、给面对面的双胎插管的技术难度、仔细监测的必要性、对大量失血、血流动力学不稳定、氧饱和度降低和体温过低等并发症的预判以及对这些并发症的处理准备和术后的密切护理。
