Spitz and Kiely proposed recommendations for administering anesthesia to conjoined twins. This can allow for relatively safe surgery by minimizing potential complications. The authors are from the Institute of Child Health and Great Ormond Street Hospital for Children in London.



(1) An anesthesiologist or group of anesthesiologists should be assigned to each patient.

(2) Each patient should be separately monitored with ECG, pulse oximetry, capnography, urinary output, and intravascular catheters.

(3) All tubes and lines should be securely attached to allow for the required changes in positioning during the surgery.

(4) A drug dose based on weight should be calculated based on the total weight of the two patients, then divided in half with each half administered to each patient.


Factors that may complicate anesthesia:

(1) One patient significantly larger than the other (may requiring adjusting the amount of drug administered to each patient).

(2) The extent of cross-circulation, which may range from minimal to significant.


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