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Doctor: Risk of infection a concern for twins
(CNN) -- Ahmed and Mohamed Ibrahim, 2-year-old twin boys who had been conjoined at the head, are resting in a drug-induced coma Monday after a 34-hour surgery to separate them. Dr. James Thomas, director of critical care at Children's Medical Center in Dallas, Texas, spoke with CNN Anchor Bill Hemmer about the twins' progress Monday. HEMMER: ... The most difficult phase we're told is over. But doctors caution the boys still have a long way to go. ... How are they this morning? THOMAS: The twins, both of them, had a very good night, and they're in good condition this morning. HEMMER: Is it possible to know if there's any brain damage at this point? THOMAS: No, it's too early to tell. We're doing everything to protect against it. And so we won't even try to wake them up for a few days yet. HEMMER: I understand their father was so excited when he heard they were separated he fainted. Is that true? THOMAS: That's true. When I came up to the waiting room, he was flat out on the floor. HEMMER: What a moment that must have been. It's my understanding, doctor, and take us through this, if you could, the true measure of success will not be known until they are awake again. When will that happen? THOMAS: Well, it's a gradual process. We keep them in a coma, a drug-induced coma, for three or four days, and then we'll lighten that coma to see how they respond. If they still are in a rocky stage, to say it that way, we'll put them back in the coma for a little bit longer. Once they do come up and they appear stable, we'll gradually withdraw different modalities of life support and let them do more and more on their own. So it's a gradual process. ... HEMMER: What's your biggest concern, doctor? THOMAS: We have two concerns right now. One is the risk or the possibility of infection occurring in this post-operative phase. They had open wounds for a prolonged period of time, and there's been a lot of skin grafting that's vulnerable to infection. The second thing we're worried about is swelling on the brain. That's a result of the surgery itself. HEMMER: Can you say whether or not any of those concerns have been addressed at this point, or is it too early? THOMAS: Well, they've been addressed in the sense that we've taken preventive measures against it. Each boy is receiving three different antibiotics to protect against infection. And the drug-induced coma is also a preventive measure to try and reduce the risk of swelling. HEMMER: There's a report this morning in The New York Times on this very case, saying doctors are most concerned with the left side of the brain. Is that accurate? THOMAS: That is accurate. That's the side of the brain that is most likely to swell if swelling is to take place. HEMMER: I wonder why that is, if you could give it to us in layman's terms. THOMAS: It has to do with the way their blood vessels were connected prior to the separation procedure. And what they did, the blood vessels from the left side of their brains drained to the right side of the opposite twin's brain. And when they divided those vessels, it creates back pressure on the left side. And so the left side has to find a way to adapt in such a way that there is no buildup of pressure in the veins on the left side of each boy's head. HEMMER: Thanks for taking us through that. One other thought here: We learned when the Iranian sisters [attempted] to separate in Singapore, there is a massive amount of tearing on the brain itself. There're real small -- I guess you'd call them veins -- that extend on the outside of the brain [and] are very delicate and a source of major concern. Is that the same in this case here, doctor? THOMAS: The anatomy of the Ibrahim twins was quite different from the anatomy of the Iranian twins. So that is -- the Iranian twins died intraoperatively. So these boys have made it through the procedure, so it's really not a concern. HEMMER: Good luck to you and your entire staff there. I know the coming days are going to keep you at it 24/7. So good luck to you. And give the family our best, too.
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