Anesthetic challenges in the separation of a rare occipital heteropagus twin: A case report

The anesthetic challenges encountered in separating heteropagus conjoined twins are unique for each case. The rarity of these surgeries and the unique anatomical variations make every separation procedure a distinct experience. This case report details the anesthetic management and the challenges faced during the separation of a heteropagus twin attached at the occiput in a 3-year, 9-month-old girl who presented for excision at a parasitic site at our tertiary care hospital. The challenges associated with our child were anticipated difficult airway, prone positioning, shared airway, the possibility of blood loss, hypothermia, hemodynamic instability, need for neuromonitoring, prolonged surgical duration of surgery with anticipation of postoperative mechanical ventilation and intensive care. Using appropriate positioning aids, airway management strategy, monitoring of depth of anesthesia, and utilization of dynamic indices for hemodynamic monitoring and post-operative intensive care ensured a safe perioperative course. Multidisciplinary collaboration, identification of perioperative challenges, and meticulous planning help in the successful management of such cases.