title: Pediatric tracheostomy in conjoined twins: multidisciplinary approach.
abstract: Tracheostomy for definitive airway management in conjoined twins is a challenge for the surgeon, anesthesiologist, and support staff. A carefully choreographed multidisciplinary approach is required. A literature search finds few reports on tracheostomy in conjoined twins. We report our experience with tracheostomy with 5.5-month-old conjoined omphalopagus twins who were attached facing each other. Initial planning led to a careful rehearsal of infant positioning focused on optimizing anterior cervical exposure. A postoperative tracheostomy care plan was also addressed. Each twin was assigned his own anesthetic team and equipment early in his life to provide consistent care for the anticipated multiple surgical procedures throughout his hospital stay. Issues addressed in this report include transportation, intubation, intraoperative airway management, the mechanical ventilatory pattern of two individuals sharing a common diaphragm, and the pharmaceutical management of two children with partially shared vascular supply.
authors.affiliation: Thomas Jefferson University Hospital, Department of Otolarynogology - Head and Neck Surgery, Philadelphia, PA 19107, USA. kylef9191@yahoo.com
authors.forename: Kyle
authors.initials: K
authors.lastname: Fisher
authors.forename: Marc
authors.initials: M
authors.lastname: Thorne
authors.forename: Dinesh
authors.initials: D
authors.lastname: Choudhry
authors.forename: Patrick
authors.initials: P
authors.lastname: Barth
authors.forename: Brian
authors.initials: B
authors.lastname: Dunham
authors.forename: Richard
authors.initials: R
authors.lastname: Schmidt
authors.forename: Judith
authors.initials: J
authors.lastname: Jones
authors.forename: Ian
authors.initials: I
authors.lastname: Jacobs
authors.forename: Steven
authors.initials: S
authors.lastname: Cook
mesh_terms: D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000379:methods*; D012121:Respiration, Artificial / Q000379:methods*; D014139:Tracheostomy / Q000379:methods*; D014428:Twins, Conjoined / Q000473:pathology / Q000601:surgery