Anesthesia for Conjoined Twins

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Anesthesia for Conjoined Twins
Conjoined twins are identical twins whose bodies are joined in utero. The occurrence is estimated to range from 1 in 50,000 to 1 in 100,000 births, with a somewhat higher occurrence in Southwest Asia and Africa. [1] The condition is more frequently found among females, with a ratio of 3:1. [2] Many are born with abnormalities incompatible with life. The overall survival rate for conjoined twins is approximately 20%. [3]
Two contradicting theories exist to explain the origins of conjoined twins. The older theory is fission, in which the fertilized egg splits partially. The second and more generally accepted theory is fusion, in which a fertilized egg completely separates, but stem cells find like-stem cells on the other twin and fuse the twins together. Conjoined twins share a single common chorion, placenta, and amniotic sac, although these characteristics are not exclusive to conjoined twins as there are some monozygotic, but non-conjoined, twins that also share these structures in utero. [4]
The term conjoined twinning refers to an incomplete splitting of monozygotic twins after 12 days of embryogenesis. The delivered fetuses are physically joined at some point as a result. The point of union is used to classify twins; the label used is the Greek word pagos, which means, "that which is fixed."[4]
• Thoraco-omphalopagus: Two bodies fused from the upper chest to the lower abdomen. These twins usually share a heart, and may also share the

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