title: Anaesthetic managements for conjoined twins with complex cardiac anomalies.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anaesthesia, National Taiwan University Hospital, Taipei, Republic of China.
authors.forename: T L
authors.initials: TL
authors.lastname: Chen
authors.forename: C J
authors.initials: CJ
authors.lastname: Lin
authors.forename: H S
authors.initials: HS
authors.lastname: Lai
authors.forename: W J
authors.initials: WJ
authors.lastname: Chen
authors.forename: C C
authors.initials: CC
authors.lastname: Chao
authors.forename: C C
authors.initials: CC
authors.lastname: Liu
mesh_terms: D000758:Anesthesia / Q000379:methods*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D014428:Twins, Conjoined / Q000601:surgery*