Chen T L, Lin C J, Lai H S, Chen W J, Chao C C, Liu C C
Department of Anaesthesia, National Taiwan University Hospital, Taipei, Republic of China.
Can J Anaesth. 1996 Nov;43(11):1161-7. doi: 10.1007/BF03011846.
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.
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.
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.
描述对三组患有复杂心脏畸形、面临动脉血氧饱和度降低和血流动力学不稳定风险的联体双胎进行手术分离的围手术期评估及麻醉管理。
三组联体双胎，分别为坐骨脐联体、脐联体和胸腹脐联体，拟在围产期或婴儿期进行分离。术前功能评估，包括连续脉搏血氧饱和度监测、二氧化碳监测和心脏电生理研究，在评估手术分离的可行性方面被认为与通过血管造影对心脏畸形和交叉循环进行解剖学评估同样重要。分别向青紫双胎和健康双胎同侧输注前列腺素E1和去氧肾上腺素，以在术中恢复动脉氧合并避免严重低氧血症。
在较弱双胎临床状况恶化之前，应精心规划并演练手术分离及麻醉过程。在手术分离期间及术后，积极的药物干预以及对交叉循环病理生理学的了解对于处理危急情况至关重要。
