الفهرس 
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Abstract
Summary
onjoined twins are defined as monochorionic monoamniotic
twins fused at any portion of their body as a result of an
incomplete division of the embryonic disk, occurring after the
13th day post conception. Conjoined twins are classified
according to the area of the bodies where the fusion takes place
and the involvement of internal organs. The symmetrical and
equal forms, in which the twins have equal or nearly equal
duplication of structures, are called duplicate completa. When
there is an unequal duplication of structures, they are called
duplicata incomplete. Conjoined twins are classified according
to the site of union by using the suffix pagus (fixed).e.g.
thoracopagus, omphalopagus , pygopagus , ischiopagus and
craniopagus.
Antenatal diagnosis is of prime importance to decide on
the management of pregnancy; termination of pregnancy may
be indicated if the diagnosis is made before the 20th week.
Decisions concerning the management of pregnancy should
always take into account survival chances following possible
surgical separation; to decide on the least traumatic route for
delivery, if pregnancy goes to term; and to alert pediatrician
Anesthetic management of conjoined twins 96
and surgical specialists to be prepared for the birth of a pair of
conjoined twins.
Conjoined twins should be nursed in the intensive care
unit like other high risk newborn babies. The postnatal
management of conjoined twins is determined by the effect of
shared viscera on stability and long term viability. Therapeutic
options include nonsurgical management, emergency
separation, or planned separation.
Anesthetizing conjoined twins involves three major
anesthetic considerations: First, two anesthesia teams need to be
available, cooperating closely in a limited workspace with
clearly separate and duplicate equipment and at times
interfering with each other. Second, the degree and clinical
significance of crossover between the two circulations must be
considered. Finally, care appropriate to the surgical procedure
must be provided in this unique setting.
Outcome, prognosis and survival after birth and
successful separation of conjoined twins depend not only upon
medical and surgical management but also upon the general
condition of the infants, the complexity of the anatomical
situation and the degree and type of organ sharing.
Mortality and morbidity of conjoined twins are better with
separation than without separation and as conjoined twin
Anesthetic management of conjoined twins 97
separation techniques improve, more patients will survive.
Examples of successfully separated twins are the Egyptian
conjoined twins Ahmed and Mohamed, the Polish conjoined
twins, the Moroccan conjoined twins Hafsah and Elham and the
Saudi conjoined twins Rana and Ranim.