Anesthesia for Conjoined Twins-Basic Principles

Conjoined twinning is a rare and fascinating congenital abnormality which occurs when the bodies of monoamniotic twins join in utero. 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. The successful perioperative management is highly dependent on a multidisciplinary team approach. It involves extensive medical work-up on patients, multiple meetings, rigorous planning, close cooperation, and coordination of all the involved specialties and supporting staff, psychosocial counselling of parents and rehearsal of planned surgical procedures. Their anesthesia management poses unique challenges due to their complex anatomical conjunctions, multiple congenital anomalies, and variable extent of cross circulation. The conduct of the anesthesia requires attention to safe airway management, intravascular access, color-coding, careful medication and intravascular volume management, temperature maintenance and positioning.