Recommendations of Spitz and Kiely for Administering Anesthesia to Conjoined Twins

Recommendations:

(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.