Investigation and Treatment of Craniopagus Twins: Anaestesia for Separation of Craniopagus Twins

In the available literature on the separation of craniopagus conjoined twins very few details are given of the anaesthetic techniques used. In one case (Hall, Merzig, and Forbes, 1957) the degree of union was obviously far less extensive than in the present cases, and anaesthesia consisted of heavy premedication followed by intubation while awake and then maintenance with nitrous oxide, oxygen, and intravenous thiopentone. Ayre's T-piece was used and blood was replaced from a 10-ml. syringe. Another case (Grossman, Sugar, Greeley, and Sadove, 1953) presented problems similar to those in this report. Heavy basal narcosis was followed by endotracheal nitrous oxide, oxygen, and minimal trichlorethylene, and 6 litres of blood was transfused. One twin died 34 days after operation and during that period was comatose, with decorticate rigidity, periodic breathing, and hypothermia, and had required tracheostomy. The other infant survived with some disability.