title: Peri-operative intensive care.
abstract: All good intensive care requires attention to detail of the routine elements of care. These include staffing and monitoring, drug prescription and administration, feeding and fluid balance, analgesia and sedation, organ support and reducing the risk of healthcare-associated infection. Doing this well requires an understanding of the relevant physiology and an awareness of the limited evidence base. Detailed protocols and implementation checklist are valuable in ensuring that these minimum standards are met. However, peri-operative care is not all predictable and amenable to protocolization. This is especially true following separation of conjoined twins. Despite the sophisticated imaging and multi-disciplinary planning that precede elective separation, the acute physiological changes in each twin cannot always be predicted reliably. In this article, we review briefly each element of peri-operative care and how this might vary in conjoined twins.
authors.affiliation: Paediatric and Neonatal Intensive Care Units, Great Ormond Street Hospital, NHS Foundation Trust, Bloomsbury, London WC1N 3JH, UK. Electronic address: Sandra.walsh@gosh.nhs.uk.
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Walsh
authors.affiliation: Paediatric and Neonatal Intensive Care Units, Great Ormond Street Hospital, NHS Foundation Trust, Bloomsbury, London WC1N 3JH, UK; Critical Care Group, Respiratory, Critical Care and Anaesthesia Unit, Institute of Child Health, University College London, London, UK.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Peters
mesh_terms: D003422:Critical Care / Q000379:methods* / Q000592:standards; D006801:Humans; D007223:Infant; D019990:Perioperative Care / Q000379:methods* / Q000592:standards; D017410:Practice Guidelines as Topic; D014428:Twins, Conjoined / Q000601:surgery*
keywords: Fluids and feeding; Haemodynamics; Sedation and analgesia; Ventilation