Anaesthetic managements for conjoined twins with complex cardiac anomalies

被引:8
作者
Chen, TL [1 ]
Lin, CJ [1 ]
Lai, HS [1 ]
Chen, WJ [1 ]
Chao, CC [1 ]
Liu, CC [1 ]
机构
[1] NATL TAIWAN UNIV HOSP, DEPT SURG, TAIPEI 100, TAIWAN
来源
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE | 1996年 / 43卷 / 11期
关键词
anaesthesia; paediatric; congenital anomaly; cardiac; twins; conjoined;
D O I
10.1007/BF03011846
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Purpose: 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. Clinical features: 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 EI and phenylephrine were applied to the cyanotic and healthy twins respectively, to restore arterial oxygenation intraoperatively and to avoid profound hypoxaemia. Conclusion: 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.
引用
收藏
页码:1161 / 1167
页数:7
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