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Canadian Anaesthetists’ Society Journal

, Volume 32, Issue 4, pp 402–411 | Cite as

Anaesthetic considerations for separation of omphalo-ischiopagus tripus twins

  • P. D. James
  • J. Lerman
  • M. E. McLeod
  • J. E. S. Relton
  • R. E. Creighton
Clinical Reports

Abstract

Anaesthesia for the separation of conjoined twins requires a multi-disciplinary team approach. We describe the anaesthetic management of a single-stage separation of 2 1/2 A-year-old omphalo-ischiopagus tripus conjoined twins. The successful 17 1/2-hour operation was conducted by five anaesthetists and 38 surgeons and nurses. Two major problems were encountered: massive blood loss in both twins (requiring transfusions of more than five and seven times their blood volumes) and a transient decrease in core temperatures after separation.

Key words

anaesthetics: paediatric genetic factors: conjoined twins 

Résumé

L’ anesthésie pour la séparation de jumeaux siamois requiert une approche multidisciplinaire. On décrit la conduite anesthésique pour des omphalo-ischiopagus tripus âgés de 2 1/2 ans. L’ opération a duré 17 1/2 heures et a été menée par cinq anesthésistes et 38 chirurgiens et infirmières. L’ opération était couronnée de succès. Cependant deux problèmes majeurs ont été rencontrés: L’ hémorragie massive requérant des transfusions supérieures à 5 et 7 fois leur volume sanguin et une diminution transitoire de ta température centrale corporelle après la séparation.

References

  1. 1.
    Eades JW, Thomas CC. Successful separation of ischiopagus tetrapus conjoined twins. Ann Surg 1966; 164:1059–72.PubMedCrossRefGoogle Scholar
  2. 2.
    Mortimer B, Kirshbaum JD. Human double monsters (so-called Siamese twins). Am J Dis Child 1942; 64:697–704.Google Scholar
  3. 3.
    Potter, EL. Pathology of the fetus and the newborn. Chicago, Year Book Publishers 1952; p. 184.Google Scholar
  4. 4.
    Kiesewetter WB. Surgery of conjoined twins (Siamese). Surgery 1966; 59:860–71.PubMedGoogle Scholar
  5. 5.
    Poradowska W, Jaworska M, Reszke S, Lodzinski K. J Pediatr Surg 1969, 4:688–93.PubMedCrossRefGoogle Scholar
  6. 6.
    Bankole MA, Oduntan SA, Oluwasanmi JA, Itayemi SO, Khwaia S. The conjoined twins of Warri, Nigeria. Arch Surg 1972; 104:294–301.PubMedGoogle Scholar
  7. 7.
    Harper R, Kenigsberg K, Sia C, Horn D, Stern D, Bongioui V. Xiphopagus conjoined twins: a 300 year review of the obstetric, morphopathologic, neonatal, and surgical parameters. Am J Obstet Gynecol 1980; 137:617–29.PubMedGoogle Scholar
  8. 8.
    Edmonds LD, Layde PM. Conjoined twins in the United States 1970-1977. Teratology 1982; 25:301–3.PubMedCrossRefGoogle Scholar
  9. 9.
    Milham S. Symmetrical conjoined twins: an analysis of the birth records of twenty-two sets. J Pediatr 1966; 69:643–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Bender C. Studies on symmetrical conjoined twins. J Pediatr 1967; 70:1010–11.PubMedCrossRefGoogle Scholar
  11. 11.
    Viljoen DL, Nelson MM, Beighton. The epidemiology of conjoined twinning in Southern Africa. Clin Genet 1983; 24:15–21.PubMedCrossRefGoogle Scholar
  12. 12.
    Aird I. The conjoined twins of Kano. Br Med J 1954; 831–7.Google Scholar
  13. 13.
    Aird I. Conjoined twins - further observations. Br Med J 1959; 1:1313–15.PubMedGoogle Scholar
  14. 14.
    Corner CW. The observed embryology of human single-ovum twins and other mutiple births. Am J Obstet Gynecol 1955; 70:933–51.PubMedGoogle Scholar
  15. 15.
    Coulton D, Hertig AT, Long WN. Monoamniotic twins. Am J Obstet Gynecol 1947; 54:119–23.PubMedGoogle Scholar
  16. 16.
    Dunbar AE. Teratology. Am J Surg 1934, 24:152-8.CrossRefGoogle Scholar
  17. 17.
    Newman HH. Differences between conjoined twins. J Hered 1931; 22:201–15.Google Scholar
  18. 18.
    O’ Connell JE, Du Boulay GH, Ballantine RIW, Jackson l, Jayes PH, Franklin AW. Surgical separation of two pairs of craniopagus twins. Br Med J 1964; 5394:1333–44.Google Scholar
  19. 19.
    Salerno LJ. Monoamniotic twinning. Obstet Gynecol 1959; 14:205–13.PubMedGoogle Scholar
  20. 20.
    Cox ML. Incidence and aetiology of multiple births in Nigeria. J Obstet Gynecol Br Comm 1963; 70:878–84.Google Scholar
  21. 21.
    Finerty JC. Parabiosis in physiological studies. Phys Reviews 1952; 32:277–302.Google Scholar
  22. 22.
    Streeter GL. Formation of single ouvum twins. Bull Johns Hopkins Hosp 1919; 33:235–9.Google Scholar
  23. 23.
    Robertson EG. Craniopagus parietalis. Arch Neural Psychiat 1953; 70:189–205.Google Scholar
  24. 24.
    Mestel AL, Golinko RJ, Wex SH et al. Ischiopagus tripus conjoined twins. Case report of a successful separation. Surgery 1971; 69:75–83.PubMedGoogle Scholar
  25. 25.
    Chao C, Susetio L, Luu K, Kwan W. Anaesthetic management for successful separation of tripus ischiopagal conjoined male twins. Can Anaesth Soc J 1980; 27:565–70.PubMedCrossRefGoogle Scholar
  26. 26.
    Spencer R. Surgical separation of Siamese twins: case report. Surgery 1956; 39:827–33.PubMedGoogle Scholar
  27. 27.
    Borde J, Mitofanoff P, Walton P, Ensel J, Durand JP. A case of asymmetrical ischiopagus symelius conjoined twins. Prog in Ped Surg 1974; 7:27–43.Google Scholar
  28. 28.
    Wilson H, Soter EH. Surgery in Siamese twins. A report of three sets of conjoined twins treated surgically. Ann Surg 1957; 145:718–25.PubMedCrossRefGoogle Scholar
  29. 29.
    Towey RM, Kisia AKL, Jacobacci S, Muoki M. Anaesthesia for the separation of conjoined twins. Anaesthesia 1979; 34:187–92.PubMedCrossRefGoogle Scholar
  30. 30.
    Tandan GC, Gade GR, Kalle NR et al. Anesthetic management for surgical separation of thoracopagus twins. Anesthesiology 1970; 33:116–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Simpson JS, Pelton DA, Swyer PR. The importance of monitoring during operations on conjoined twins. Can Anaesth Soc J 1967; 96:1463–7.Google Scholar
  32. 32.
    Jarem BJ, Flewellen EH, Tyson KRT. Anesthetic management for separation of conjoined twins. Anesthesiol Rev 1977; 4:17–22.Google Scholar
  33. 33.
    Bird TM and Strunin L. Anaesthetic considerations for microsurgical repair of limbs. Can Anaesth Soc J 1984; 31:51–60.PubMedCrossRefGoogle Scholar
  34. 34.
    Steward DJ. Manual of pediatric anesthesia. Second edition, New York, Churchill Livingstone, 1985; pp. 351–2.Google Scholar
  35. 35.
    Eger EI II. Anesthetic uptake and action. Baltimore, Williams & Wilkins, 1974; p. 82.Google Scholar
  36. 36.
    The Experts Opine — Survey of Anesthesiology; 1984; 28: 143–9.Google Scholar

Copyright information

© Canadian Anesthesiologists 1985

Authors and Affiliations

  • P. D. James
    • 1
  • J. Lerman
    • 1
  • M. E. McLeod
    • 1
  • J. E. S. Relton
    • 1
  • R. E. Creighton
    • 1
  1. 1.Department of AnaesthesiaThe Hospital for Sick ChildrenToronto

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