Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942010000300009
Brazilian Journal of Anesthesiology
Clinical Information

Anestesia para separação cirúrgica de emergência de onfalópogos

Anesthesia for emergency separation of omphalopagus conjoined twins

Adriano Bechara de Souza Hobaika; Kléber Costa de Castro Pires; Vitto Bruce Salles Alves Fernandes

http://dx.doi.org/10.1590/S0034-70942010000300009 Braz J Anesthesiol, vol.60, n3, p.311-314, 2010
PDF Português
PDF English
Downloads: 0
Views: 892

Resumo

JUSTIFICATIVA E OBJETIVOS: A taxa de mortalidade da cirurgia de separação de gêmeos unidos no período neonatal é de 50%, podendo chegar a 75% se ocorrer em situação de emergência. O planejamento da cirurgia de separação é meticuloso e envolve exames de imagem, avaliação da circulação cruzada e até a realização de outros procedimentos cirúrgicos de preparação, como a expansão de pele. RELATO DO CASO: Gêmeas onfalópogas com 11 dias de vida foram separadas em caráter de emergência devido ao óbito da irmã por sepse associada à cardiopatia. O fígado era um órgão comum e foi separado. A gêmea sobrevivente veio a óbito seis dias depois. CONCLUSÕES: A separação no período neonatal deve ser evitada devido à imaturidade dos sistemas orgânicos dos pacientes. Contudo, situações de emergência como esta podem impor a realização do procedimento.

Palavras-chave

ANESTESIA, CIRURGIA, CIRURGIA

Abstract

BACKGROUND AND OBJECTIVES: The rate of mortality during the surgical separation of conjoined twins in the neonatal period is 50% and can reach up to 75% if it occurs in emergency situations. The planning of the surgical separation procedure is detailed and involves imaging assessment, evaluation of cross-circulation and even other surgical preparation procedures, such as skin expansion. CASE REPORT: Eleven-day-old female omphalopagus conjoined twins underwent emergency surgical separation due to the death of one twin caused by sepsis associated to cardiopathy. The liver was shared by the twins and was separated. The surviving twin died six days later. CONCLUSIONS: Surgical separation of conjoined twins in the neonatal period must be avoided due to the patients' organic system immaturity. However, emergency situations such as the one described herein can require the procedure to be carried out.

Keywords

ANESTHESIA, SURGERY, SURGERY

References

Cywes S, Millar AJW, Rode H. Conjoined twins: the Cape Town experience. Pediatr Surg Int. 1997;12:234-248.

Cywes S, Davies MRQ, Rode H. Conjoined twins: the Red Cross War Memorial Children's Hospital experience. S Afr J Surg. 1982;20:105-118.

O'Neill Jr JA, Holcomb CW, Schnaffer L. Surgical experience with thirteen conjoined twins. Ann Surg. 1988;208:299-312.

Thomas JM, Lopez JT. Conjoined twins: the anaesthetic management of 15 sets from 1991-2002. Pediatr Anesth. 2004;14:117-129.

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

Leelanukrom R, Somboonviboon W, Bunburaphong P. Anaesthetic experiences in three sets of conjoined twins in King Chulalongkorn Memorial Hospital. Pediatr Anesth. 2004;14:176-183.

Graivier L, Jacoby MD. Emergency separation of newborn conjoined (Siamese) twins. Tex Med. 1980;76:60-62.

Mabogunje OA, Lawrie JH. Conjoined twins in West Africa. Arch Dis Child. 1980;55:626-630.

Ure BM, Holschneider AM, Gharib M. Zur Nottrennung eines neugeborene Xypho-Omphalopagen-Paares. Z Kinderchir. 1989;44:176-180.

Spitz L, Kiely EM. Experience in the management of conjoined twins. Br J Surg. 2002;89:1188-1192.

Saguil E, Almonte J, Baltazar W. Conjoined twins in the Philippines: experience of a single institution. Pediatr Surg Int. 2009;25:775-780.

Watanatittan S, Niramis R, Suwatanaviroj A. Conjoined twins: surgical separation in 11 cases. J Med Assoc Thai. 2003;86(^s3):S633-643.

Jaffray B, Russell SA, Bianchi A. Necrotizing enterocolitis in omphalopagus conjoined twins. J Pediatr Surg. 1999;34:1304-1306.

Rudiger A, Singer M. Mechanisms of sepsis-induced cardiac dysfunction. Crit Care Med. 2007;35:1599-1608.

Módolo NSP, Amorim RB, Castiglia YMM. Anestesia para separação de gêmeos isquiópagos no período neonatal: Relato de caso. Rev Bras Anestesiol. 2002;52:446-452.

Motoyama EK, Davis PJ. Smith's Anesthesia for Infants and Children. 1996.

5dd2dc2d0e8825f50ac63493 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections