Objective: To investigate cardiovascular problems during anesthesia.

Material and Method: 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.

Results: 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.

Conclusion: 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.

Keywords: Chimney, TEVAR, Innominate, Blood loss estimation, Hypotension