{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:38:08Z","timestamp":1787071088572,"version":"build-2736575974"},"reference-count":7,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:p>Conjoined twins are one of the most fascinating human malformations. Here, we report the anesthetic management and challenges faced in performing the successful separation surgery of 4-day-old thoraco-omphalopagus conjoined twins, born at term to a multigravida by elective caesarean section weighing 3.5 kg with APGAR score of more than 7. Computerized tomography scan revealed fused anterior surface of the left lobe of liver with common left portal vein. Confirmation of cross-circulation between the twins was done by giving intravenous midazolam to one of the conjoined twins, but no effect seen in the other one. We highlighted the responsibility of anesthesia team in anesthetizing sequentially the two patients who are joined together, technical difficulty of intubating the twins facing each other, need of careful monitoring, anticipation of complications such as massive blood loss, hemodynamic instability, desaturation, and hypothermia, and preparedness for their management and vigilant postoperative care.<\/jats:p>","DOI":"10.4103\/sja.sja_142_19","type":"journal-article","created":{"date-parts":[[2020,1,7]],"date-time":"2020-01-07T05:44:53Z","timestamp":1578375893000},"page":"100-103","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Our experience with anesthetic management of conjoined twins' separation surgery"],"prefix":"10.4103","volume":"14","author":[{"given":"Amber","family":"Rawat","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Institute of Medical Sciences-Banaras Hindu University (IMS-BHU), Varanasi, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richa","family":"Rai","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Institute of Medical Sciences-Banaras Hindu University (IMS-BHU), Varanasi, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anil K.","family":"Paswan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Institute of Medical Sciences-Banaras Hindu University (IMS-BHU), Varanasi, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vaibhav","family":"Pandey","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, Institute of Medical Sciences-Banaras Hindu University (IMS-BHU), Varanasi, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,1,6]]},"reference":[{"key":"R2-20250925","doi-asserted-by":"crossref","first-page":"65","DOI":"10.5603\/AIT.2014.0014","article-title":"Anaesthesia of conjoined twins \u2013 Case series","volume":"46","author":"Kobylarz","year":"2014","journal-title":"Anaesthesiol Intensive Ther"},{"key":"R3-20250925","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1007\/s00381-004-0980-9","article-title":"Thomas anaesthesia for conjoined twins","volume":"20","author":"Jenny","year":"2004","journal-title":"Childs Nerv Syst"},{"key":"R4-20250925","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1213\/00000539-198004000-00017","article-title":"Cardiopagus in neonatal thoracopagus twins: Anaesthetic management","volume":"59","author":"Bloch","year":"1980","journal-title":"Anesth Analg"},{"key":"R5-20250925","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1213\/01.ANE.0000078588.36983.08","article-title":"Anaesthetic management for a five-day separation of craniopagus twins","volume":"97","author":"Wong","year":"2003","journal-title":"Anesth Analg"},{"key":"R6-20250925","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1097\/00000658-198809000-00007","article-title":"Surgical experience with thirteen conjoined twins","volume":"208","author":"O\u2019Neill","year":"1988","journal-title":"Ann Surg"},{"key":"R7-20250925","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1007\/BF03028313","article-title":"Separation of omphalopagus conjoined twins using combined caudal epidural-general anaesthesia","volume":"48","author":"Grecnberg","year":"2001","journal-title":"Can J Anaesth"},{"key":"R8-20250925","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1213\/01.ANE.0000153503.38099.63","article-title":"Moral permissibility as a guide for decision making about conjoined twins","volume":"101","author":"Waisel","year":"2005","journal-title":"Anesth Analg"}],"container-title":["Saudi Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/sja.SJA_142_19","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:41:17Z","timestamp":1787067677000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/sja.SJA_142_19"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1]]},"references-count":7,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.4103\/sja.sja_142_19","relation":{},"ISSN":["1658-354X","0975-3125"],"issn-type":[{"value":"1658-354X","type":"print"},{"value":"0975-3125","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1]]},"assertion":[{"value":"2019-02-23","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-05-25","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}