[Anesthetic management of cesarean section for conjoined twins]

A 31-year-old female patient underwent cesarean section for conjoined twins under general anesthesia. In the 33rd week of pregnancy, MRI showed the twins to be a thoracopagus, whose hearts and livers are combined. The patient was not informed that her fetus combined. General anesthesia was induced with thiamylal 200 mg and vecuronium 8 mg in the presence of two pediatricians. Anesthesia was maintained with 66% nitrous oxide in oxygen until the delivery. Just after the delivery, methylergometrine maleate 0.2 mg, midazolam 5 mg, and fentanyl 100 micrograms were administered intravenously. PGF2 alpha was administered in the uterus because of inadequate contraction of the uterus. Apgar score was 0 point at both 1 minute and 5 minutes. Autopsy showed their hearts and livers combined. Conjoined twins tend to die early after birth because of abnormality in their hearts. We selected general anesthesia for this case considering mother's feeling, and we successfully held intraoperative bleeding down with methylergometrine maleate and extra PGF2 alpha.