Conjoined twins - the anaesthetic management
of 15 sets from 1991-2002

Thomas JM, Lopez JT.
Department of Paediatric Anaesthesia,
Red Cross War Memorial Children's Hospital,
University of Cape Town,
Rondebosch, Cape Town, South Africa.
Paediatr Anaesth. 2004 Feb;14(2):117-29


The Red Cross War Memorial Children's Hospital, Cape Town, South Africa is the only dedicated children's hospital in sub-Saharan Africa and, as such, is the referral hospital for complex procedures from this region. Fifteen sets of conjoined twins have presented for separation from 1991 to 2002, and a total of 34 sets since 1964. Anaesthesia for procedures on conjoined twins is a demanding, exacting and meticulous exercise, whether prior to or during separation. Anaesthesia forms part of the multidisciplinary management of the babies. Emphasis is laid on preoperative assessment, goal-directed planning of theatre and the staff involved in the surgery, duplication of all equipment necessary for anaesthetizing and monitoring two infants in one operating room, and having plans in place to avoid overcrowding. Challenges encountered in anaesthesia for these twins include identifying anatomical conjunctions, airway management, acquiring vascular access, the potential for enormous blood loss, and maintaining normothermia. Planning for the postseparation period and the reconstruction and rehabilitation of the babies is essential from the time of their initial admission. Meticulous attention to detail, monitoring and vigilance are mandatory. Successful management of conjoined twins relies on close communication and cooperation of all members of the multidisciplinary team.
Adverse effects
Obstetric anaesthesia
Molecular mechanisms
Inhalational techniques
'The secularisation of pain'
Anaesthesia: rivalries and discoveries
Volatile anaesthetics immobilise sensitive plant

and further reading
Future Opioids
BLTC Research
Utopian Surgery?
The Good Drug Guide
The Abolitionist Project
The Hedonistic Imperative
The Reproductive Revolution
Critique of Huxley's Brave New World