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BJA Advance Access published online on January 16, 2006
British Journal of Anaesthesia, doi:10.1093/bja/aei313
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted November 30, 2005

Case Report

Anaesthetic management of thoracopagus twins with complex cyanotic heart disease for cardiac assessment: special considerations related to ventilation and cross-circulation

P. Szmuk 1 *, M. F. Rabb 2, B. Curry 2, K. J. Smith 2, M. R. Lantin-Hermoso 3, and T. Ezri 4

1 Department of Anesthesiology, Division of Cardiology, University of Texas Medical School at Houston, TX, USA; Outcomes ResearchTM Institute, Louisville, KY, USA
2 Department of Anesthesiology, Division of Cardiology, University of Texas Medical School at Houston, TX, USA
3 Department of Pediatrics, Division of Cardiology, University of Texas Medical School at Houston, TX, USA
4 Outcomes ResearchTM Institute, Louisville, KY, USA; Department of Anesthesia, Wolfson Medical Center, Holon, Affiliated to Sackler School of Medicine, Tel Aviv University, Israel

* To whom correspondence should be addressed.
P. Szmuk, E-mail: pszmuk{at}gmail.com


  Abstract

We describe the anaesthetic management of a pair of thoracopagus twins of 14 months of age undergoing complex cardiac evaluation. Synchronous ventilation of the twins, needed for the ECG-gated magnetic resonance imaging-angiography, was achieved through a Carlens (Y) adaptor during procedures and transport. The complex logistical implications are obvious. We also describe the first use of bispectral index monitor for detection of cross-circulation in conjoint twins.

Keywords: anaesthesia, paediatric; conjoint twins; monitoring, bispectral index.
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