Anaesthetic considerations for separation of omphalo-ischiopagus tripus twins

Anaesthesia for the separation of conjoined twins requires a multi-disciplinary team approach. We describe the anaesthetic management of a single-stage separation of 2 1/2-year-old omphalo-ischiopagus tripus conjoined twins. The successful 17 1/2-hour operation was conducted by five anaesthetists and 38 surgeons and nurses. Two major problems were encountered: massive blood loss in both twins (requiring transfusions of more than five and seven times their blood volumes) and a transient decrease in core temperatures after separation.