the anesthesia team behind the "connected" documentary

One of the most critical aspects of any surgery is anesthesia. Putting kids asleep and ensuring they stay asleep through surgery and wake up safely is a delicate balance that the anesthesiology team at Dayton Children’s manages each day with surgery patients.

The anesthesiology team at Dayton Children’s prepares for and treats each child and their unique needs. For Pedro and Augusto, the same rules applied.

All of the anesthesiologists at Dayton Children’s are pediatric board certified and only take care of children. Children have very different physiology as they grew from infants to adults. Therefore, they need an anesthesiologist who is trained in their special needs and how their bodies react differently to medications typically used during surgery.

Once the team knew the boys were coming to Dayton for surgery, the preparations began. We sat down with Dr. Sean Antosh, MD, pediatric anesthesiologist and lead for all things anesthesia when it came to the twins, to learn more about his approach for this case.

Tell us about the team involved in Pedro and Augusto’s care.

There was a dedicated team of six anesthesiologists and four nurse anesthetists who donated their time for the cases. The team rotated from case to case and I lead the team for every anesthetic.

Teams were always separated by blue and grey, to make sure we had a dedicated team per twin. We needed to have two anesthesia setups for every anesthetic, to include ventilators, medications, medication machines, etc. Additionally, we always had to be prepared for emergency separation if there was an issue where one or both twins needed resuscitation. 

What planning did you have to do prior to the surgeries?
The team planned for more than a year through extensive literature review of previous craniopagus twins and their anesthesia management. 

We also discussed with colleagues at other institutions about how they have taken care of similar patients in the past. 

How was medical imaging involved?
We created detailed step-by-step plans to walk through the anticipated course of events. We also conducted multiple practice sessions for each imaging study due to changes in location and setups.

During the first several anesthetics, we tested how long it took for a medication given to one twin to reach the other twin. This allowed us to determine the extent of the blood connection between the two and how each affected the other's anesthetic. 

How did you practice in case of an emergency?  
At the core of our training were departmental and hospital wide mock codes to practice resuscitating the twins in case of an emergency.

A new "code blue double" was developed to notify the team that a code blue requiring more resources than typical was occurring. Specific color-coded team member role stickers were developed to facilitate the resuscitation of the twins and throughout the twin's hospital stay, two defibrillators were always available at bedside, in case they were needed. 

What was involved when it came time for surgery?
We always started anesthesia with blue twin (Augusto) to go off to sleep, followed by grey twin (Pedro). Each team worked independently; however, we were in constant communication with one another.

Pedro's blood pressure was always lower than Augusto's, so we had to be cognizant of the level of anesthesia for Pedro. Additionally, we were always prepared for massive transfusion of blood products for both boys - which required constant communication and collaboration with the blood bank.

For the final separation, we had a rotating schedule which was extended for 72+ hours. Due to the critical nature, we had anesthesiologists in the operating rooms overnight to provide care even though surgery was not underway.
 

watch the connected documentary 

To learn more about Pedro and Augusto, watch the connected documentary today.