Thoracic Endovascular Aortic Repair with Chimney Technique (Chimney TEVAR) for Aortic Arch Pathologies: Cardiovascular Problems during Anesthesia
Sindhvananda, W.; Leelachiewchankul, F.
Journal of the Medical Association of Thailand 99(12): 1328-1336
2016
ISSN/ISBN: 0125-2208 PMID: 29952521 Document Number: 17580
Chimney TEVAR is a new alternative surgical treatment for aortic arch pathologies. As being a developing surgical technique, there might be some unknown cardiovascular problems during anesthesia. To investigate cardiovascular problems during anesthesia. Retrospective review of medical records between 2010 and 2013 found that chimney TEVAR were operated in 16 cases. From anesthetic records, cardiovascular parameters were collected and descriptive statistic and pair-t-test were applied; abnormal events were focused, traced, and logically depicted. During chimney insertion, NIBP (at left) were used instead of IBP (at right) in 50% of cases, MAP was lowest, and CVP was increased. Overall during surgery, decreasing of MAP from baseline (mean = -36.25±21.94 mmHg) was observed throughout the operation and with statistical significance. Serious cardiovascular instability of 12.5% were observed. Base on blood transfusion and hematocrit level, the assessed amount of blood loss was inappropriate and underestimated in 75% of cases. 1) It was not safe to monitor blood pressure only at right arm, 2) underestimated assessment of blood loss was common and caused hypotension, 3) volume status was hardly assessed by basic monitors and CVP did not help for volume assessment, and 4) fatal cardiovascular instability could happen.
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