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Conjoined twins are a rare congenital anomaly. The extent of organ sharing and cross circulation between twins determine the possibility and prognosis of a separation procedure. In this case anaesthetic management for successful separation of omphalopagus conjoined twins at day three of life is presented. Authors emphasise the importance of an integrated approach, thorough preoperative evaluation and planning, vigilant intraoperative monitoring and anticipation and management of complications like hypothermia, hypotension, hypokalaemia, hypocalcaemia and postoperative concerns and care.