Brazilian journal of anesthesiology (Elsevier)
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Case Reports
[Anesthesia and perioperative challenges for surgical separation of thoraco-omphalopagus twins: case report].
Conjoined twins are monozygotic twins physically joined at some part of the body. This is a rare phenomenon, estimated between 1:50,000 to 1:200,000 births. The objective of this report is to present the anesthetic management and the perioperative challenges for a separation surgery. ⋯ Conjoined twin separation surgery is a challenge, which requires planning and coordination of a multidisciplinary team during all stages.
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Malignant hyperthermia is an autosomal dominant hypermetabolic pharmacogenetic syndrome, with a mortality rate of 10%-20%, which is triggered by the use of halogenated inhaled anesthetics or muscle relaxant 10%-20% succinylcholine. The gold standard for suspected susceptibility to malignant hyperthermia is the in vitro muscle contracture test in response to halothane and caffeine. The determination of susceptibility in suspected families allows the planning of safe anesthesia without triggering agents for patients with known susceptibility to malignant hyperthermia by positive in vitro muscle contracture test. Moreover, the patient whose suspicion of malignant hyperthermia was excluded by the in vitro negative muscle contracture test may undergo standard anesthesia. Susceptibility to malignant hyperthermia has a variable manifestation ranging from an asymptomatic subject presenting a crisis of malignant hyperthermia during anesthesia with triggering agents to a patient with atrophy and muscle weakness due to central core myopathy. The aim of this study is to analyze the profile of reports of susceptibility to malignant hyperthermia confirmed with in vitro muscle contracture test. ⋯ The crises of malignant hyperthermia resembled those described in other countries, but with frequency lower than that estimated in the country.