Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942002000400008
Brazilian Journal of Anesthesiology
Clinical Information

Anestesia para separação de gêmeos isquiópagos no período neonatal: relato de caso

Anesthetic management for neonatal conjoined twins separation: case report

Norma Sueli Pinheiro Módolo; Rosa Beatriz Amorim; Yara Marcondes Machado Castiglia; Simone A. Dias; Valter M. Guasti

http://dx.doi.org/10.1590/S0034-70942002000400008 Braz J Anesthesiol, vol.52, n4, p.446-452, 2002
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Resumo

JUSTIFICATIVA E OBJETIVOS: A separação de gêmeos unidos causa grande interesse devido à complexidade da anestesia e cirurgia, à raridade da patologia e às poucas chances de sobrevida. O objetivo desta descrição é o de contribuir para a literatura existente, relatando os desafios encontrados por nossa equipe no atendimento à cirurgia-anestesia de separação de gêmeos isquiópagos. RELATO DO CASO: Pacientes gêmeos, nascidos a termo, de parto cesariano, pesando juntos 5.100 g, classificados como isquiópagus tetrapus. Duas equipes anestésico-cirúrgicas estavam presentes, sendo o procedimento anestésico esquematizado com aparelho de anestesia, cardioscópio, capnógrafo, oxímetro de pulso, termômetro elétrico, estetoscópio esofágico, todos em dobro. Realizou-se indução anestésica com halotano e fentanil, com os gêmeos em posição lateral e com rotação da cabeça em 45º para facilitar a intubação traqueal. Os recém-nascidos foram mantidos em ventilação controlada manualmente, utilizando o sistema de Rees-Baraka. A anestesia foi mantida com halotano, oxigênio e fentanil. Durante o per-operatório, foram encontrados órgãos abdominais duplos, com exceção do cólon, que era único. As bexigas e os ísquios estavam ligados. Ao final da cirurgia as duas crianças apresentavam-se com sinais vitais estáveis. Os gêmeos permaneceram na Unidade de Terapia Intensiva (UTI) Neonatal por quatro semanas e receberam alta em bom estado geral. CONCLUSÕES: Ressalta-se a importância do entrosamento da equipe, do estudo retrospectivo multidisciplinar, da monitorização adequada e acurada observação clínica; todos esses fatores contribuíram para a boa evolução e alta dos gêmeos.

Palavras-chave

ANESTESIA, CIRURGIA, CIRURGIA

Abstract

BACKGROUND AND OBJECTIVES: The separation of conjoined twins has always raised considerable interest because of surgical and anesthetic complexity, pathology rarity and few survival chances. The goal of this description was to contribute to existing literature by reporting the challenges faced by our team during an anesthetic-surgical procedure for ischiopagus twins separation. CASE REPORT: Term conjoined twins, born from Cesarean section, weighing together 5100 g, who were classified as ischiopagus tetrapus. Two anesthetic-surgical teams were present and the anesthetic procedure was programmed using two units of each device: anesthesia machine, cardioscope, capnograph, pulse oximetry, electric thermometer and esophageal stethoscope. Halothane and fentanyl were used for anesthesia induction, with the twins in the lateral position and 45º head rotation to allow tracheal intubation. Ventilation was manually controlled using Rees-Baraka systems. Anesthesia was also maintained with halothane, fentanyl and oxygen. Double abdominal organs were found during surgery, except for the single colon. Bladders and ischia were joined. At surgery completion, twins had stable vital signs. They remained in Neonatal Intensive Care Unit for four weeks and were discharged in good general conditions. CONCLUSIONS: The importance of the team’s "meshing of gears", multidisciplinary retrospective studies, adequate and careful monitoring and good clinical observation is emphasized. All those factors contributed for twins’ good evolution.

Keywords

ANESTHESIA, SURGERY, SURGERY

References

Bender C. Studies on symmetrial conjoined twins. J Pediatr. 1967;70:1010-1011.

Diaz JH, Furman EB. Perioperative management of conjoined twins. Anesthesiology. 1987;67:965-973.

Luckhardt AB. Report of the autopsy of the siamese twins with other interesting information covering their life: a Sketch of the life of Chang and Eng.. Surg Gynecol Obstet. 1941;72:116-125.

Bloch EC, Karis JH. Cardiopagus in neonatal thoracopagus twins: medical, surgical and ethical challenges. Anesth Analg. 1980;59:304-307.

Antonelli D, Shmilovitz L, Dharan M. Conjoined hearts. Br Heart J. 1986;56:486-488.

Wong KC, Ohmura A, Roberts TH. Anesthetic management for separation of craniopagus twins. Anesth Analg. 1980;59:883-886.

Sabbag F, Tenório SB, Wendler E. Anestesia para separação de gêmeos tóraco-onfalópagos. Rev Bras Anestesiol. 1988;38:197-200.

Diaz JH, Furman EB. Perioperative management of conjoined twins. Anesthesio- logy. 1987;67:965-973.

Chen TL, Lin CJ, Lai HS. Anaesthetic managements for conjoined twins with complex cardiac anomalies. Can J Anaesth. 1996;43:1161-1167.

Spencer R. Surgical separation of siamese twins: Case report. Surgery. 1956;39:827-828.

Eades JW, Thomas CG. Successful separation of ischiopagus tetrapus conjoined twins. Ann Surg. 1966;164:1059-1060.

Mestel AL, Golinko RJ, Wax SH. Isquiopagus tripus conjoined twins: case report of a successful separation. Surgery. 1971;69:75-83.

Borde J, Mitrofanoff P, Wallon P. A case of asymmetrical ischiopagus symelius conjoined twins. Prog Ped Surg. 1974;7:27- 43.

O’Neil Jr JR, Holcomb GWIII, Schnauffer L. Surgical experience with thirteen conjoined twins. Ann Surg. 1988;208:299-312.

Motoyama EK, Davis PJ. Smith’s Anesthesia for infants and children. 1996:999.

Gans SL, Morgenstern L, Gettelman E. Separation of conjoined twins in the newborn period. J Pediatr Surg. 1968;3:565-569.

Chao C-C, Susetio L, Lin WK. Anaesthetic management for successful separation of tripus ischiopagus conjoined male twins. Can Anaesth Soc J. 1980;27:565-571.

Tandan GC, Gode GR, Kalle NR. Anaesthetic management for surgical separation of thoracopagus twins. Anesthesiology. 1970;23:116-119.

Norwitz ER, Hoyte LPJ, Jenkins KJ. Separation of conjoined twins with the twin reversed - arterial - perfusion sequence after prenatal planning with three-dimensional modeling. N Engl J Med. 2000;343:399-402.

Roy M. Anaesthesia for separation of conjoined twins. Anaesthesia. 1984;39:1225-1228.

Towey RM, Kisia AKL, Jacobacci S. Anaesthesia for the separation of conjoined twins. Anaesthesia. 1979;34:187-192.

Hird I. The conjoined twins of Kano. Brit Med J. 1974;1:831-837.

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