Anaesthetic management of a patient with thoracopagus

We report the case of a 10-day-old male child weighing 3.5 kg, with mass over the sternal region, a set of four limbs and an omphalocoele that had undergone surgical separation. An exoparasitic twin had fully developed hind limbs, well-developed genitalia, one fully developed upper limb and another, underdeveloped upper limb. Echocardiography and a computed tomographic scan revealed no gross cardiac anomaly and the sharing of any other major organ was absent. The limbs of the parasite were lying in front of the neck and interfered with holding the mask in position. One anaesthetist held these limbs apart. We avoided the use of muscle relaxant out of fear that the large mass could hamper ventilation. The neonate was intubated successfully under deep inhalation anaesthesia. He had an uneventful recovery.