الفهرس 
Classification and Prenatal EvaluationOnly 14 pages are availabe for public view
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Abstract
Conjoined twinning is one of the most fascinating human malformations. Treating conjoined twins can be a daunting challenge for the surgeon as well as anaesthesiologist. Surgical separations occur more frequently
and with greater success than before.
The decision of separation when dealing with conjoined twins is an extremely complicated one. It is a decision to be made solely by the parents.
Surgery to separate conjoined twins may range from relatively simple to extremely complex, depending on the point of attachment and the internal parts that are shared. Most cases of separation are extremely risky and life-threatening.
Prenatal diagnosis allows careful planning for delivery and for preoperative assessment.
Better preconceptual maternal nutrition with folic acid supplementation is likely to reduce the incidence of twinning abnormalities. If the diagnosis is made antenatally, then the decision to terminate the pregnancy may be taken after detailed evaluation and counseling.
Delivery at a tertiary centre is recommended for optimal neonatal intensive care and pediatric surgical intervention.
Emergency surgery may be required, but it is preferable to delay surgery to allow growth and the completion of investigations.
Detailed preoperative assessment is essential to determine the best surgical approach, reconstruction methods and ultimate outcome.
Separation of conjoined twins is a complicated procedure. The importance of a multidisciplinary team with rehearsal of all aspects (surgical, anaesthetic and nursing) of the operative procedure cannot be overemphasized.
It is a multidisciplinary team approach involving extensive medical work-up on patients, multiple meetings and discussions with all the involved specialties and supporting staff, involvement of parents, Psychosocial counseling of parents, rehearsal of the planned surgical procedure, media contact prior to Surgery.
The rationale for deferring surgery should include single heart, major communicating hearts or major anomalies.
Goals of the anaesthesia care are to pay meticulous attention to detail, monitoring, and vigilance, planning for the postoperative care in the intensive care unit (ICU), by a dedicated team of anaesthesiologists and intensivists for each child with duplication of all monitoring and equipment in one operating room.
Induction of anaesthesia in such patients requires an experienced anaesthetist. As far as conjoined twins are concerned, the recommended intravenous doses of anaesthetic agents for the combined body weight of the twins are usually halved and then divided into two equal doses, with one being administered to each twin. Reduced incremental doses are titrated against response and help to minimise the dangers of compounding the drug effect.
The main problems during the operation are the unusual position of the patients, profuse blood loss, prolonged operation on two patients on the same table and the number of medical personnel involved.
Challenges encountered in anesthesia for these twins include identifying anatomical conjunctions, airway management, acquiring vascular access, the potential for enormous blood loss, and maintaining normothermia.
Planning for the postsoperative period and the reconstruction and rehabilitation of the babies is essential from the time of their initial admission.
Although the outcome is influenced by careful planning and organization from all participants, the prognosis is often predetermined by the underlying anatomy which may preclude
successful separation.
Successful management of conjoined twins relies on close communication and cooperation of all members of the multidisciplinary team.