Does Parsonnet scoring model predict mortality following adult cardiac surgery in India.

Aims and Objectives: To validate the Parsonnet scoring model to predict mortality following adult cardiac surgery in Indian scenario. Materials and Methods: A total of 889 consecutive patients undergoing adult cardiac surgery between January 2010 and April 2011 were included in the study. The Parsonnet score was determined for each patient and its predictive ability for in‑hospital mortality was evaluated. The validation of Parsonnet score was performed for the total data and separately for the sub‑groups coronary artery bypass grafting (CABG), valve surgery and combined procedures (CABG with valve surgery). The model calibration was performed using Hosmer–Lemeshow goodness of fit test and receiver operating characteristics (ROC) analysis for discrimination. Independent predictors of mortality were assessed from the variables used in the Parsonnet score by multivariate regression analysis. Results: The overall mortality was 6.3% (56 patients), 7.1% (34 patients) for CABG, 4.3% (16 patients) for valve surgery and 16.2% (6 patients) for combined procedures. The Hosmer–Lemeshow statistic was <0.05 for the total data and also within the sub‑groups suggesting that the predicted outcome using Parsonnet score did not match the observed outcome. The area under the ROC curve for the total data was 0.699 (95% confidence interval 0.62–0.77) and when tested separately, it was 0.73 (0.64–0.81) for CABG, 0.79 (0.63–0.92) for valve surgery (good discriminatory ability) and only 0.55 (0.26–0.83) for combined procedures. The independent predictors of mortality determined for the total data were low ejection fraction (odds ratio [OR] ‑ 1.7), preoperative intra‑aortic balloon pump (OR ‑ 10.7), combined procedures (OR ‑ 5.1), dialysis dependency (OR ‑ 23.4), and re‑operation (OR ‑ 9.4). Conclusions: The Parsonnet score yielded a good predictive value for valve surgeries, moderate predictive value for the total data and for CABG and poor predictive value for combined procedures

Coagulopathy following venous air embolism: a disastrous consequence: a case report / 대한마취과학회지

Venous air embolism (VAE) is a life-threatening complication of some surgical procedures. Though occurrence of VAE is frequent during neurosurgical procedures, coagulopathy following VAE has not previously been reported. Coagulation abnormalities are more commonly reported associated with fat or amniotic fluid embolism, but rarely with VAE. We present a case of massive VAE in sitting position leading to fatal coagulopathy even after successful resuscitation following the event. Coagulation abnormalities and bleeding can produce catastrophic consequences in neurosurgical patients. This report emphasizes the possibility of this potentially fatal complication in patients who have sustained a massive VAE.