The Special Committee Investigating Deaths Under Anaesthesia (SCIDUA) reviews all deaths under or within 24 h of anaesthesia in the Australian state of New South Wales, with a population of 5.7 million. The Committee is appointed by the Minister for Health, is legally privileged and provides complete confidentiality of its investigations. Deaths are reported to SCIDU by the State Coroner's Office. The anaesthetist involved in each case then is asked to complete and voluntarily return a questionnaire on the event. There is a 92% response rate.In reviewing 1503 deaths in approximately 3.5 million surgical procedures between 1984 and 1990, the Committee concluded that factors under the control of the anaesthetist caused or significantly contributed to the deaths of 172 patients. No better alternative procedure was available in 11 of the cases and, in these, the procedure was carried out properly. The findings demonstrate a rate of one anaesthesia related death in 20 000 operations, compared with 1:5500 in 1960 and 1:lO 250 in 1970.In children under ten years of age, there were 76 deaths investigated, with approximately 280 000 operations in this age group. sixty-three percent of the children were less than one year. The operations involved were chiefly cardiothoracic, laparotomies for necrotising enterocolitis in premature neonates and trauma surgery. Anaesthetic factors were implicated in only one of the 76 deaths.While there are limitations to the study, in its 34 years SCIDUA has provided a credible estimate of anaesthesia related mortality and been able to highlight features of its incidence and pattern. The major anaesthetic factors relating to the deaths remain inadequate pre-and postoperative care, inappropriate choice of anaesthetic technique or drugs and overdosage with anaesthetic agents.
The New South Wales Special Committee Investigating Deaths Under Anaesthesia classified 1503 deaths before full recovery from anaesthesia occurring between 1984 and 1990. 172 deaths were attributed to anaesthesia, including 11 in which the anaesthetic choice or management could not be criticized. In the remaining 161 an average of 1.8 errors per case were identified, the most frequent being inadequate preparation of the patient (in 72 cases), inadequate postoperative care (52 cases), the technique of anaesthesia chosen (44 cases) and overdose (43 cases). Death was most commonly attributed to anaesthesia in elderly patients (modal age group 70–79), in males (1.9:1) and was most commonly associated with abdominal and orthopaedic operations. Urgent non-emergency cases, 10% of the 1503 cases classified, constituted 26% of those deaths attributed to anaesthesia. One death attributable to anaesthesia occurred per 20,000 operations and the rate of such deaths was 0.44 per 100,000 population per annum.
Some effects of the /3-adrenergic receptor blocker, propranolol, were studied in 20 normal, fasting, conscious men. The measurements made included cardiac output, splanchnic blood flow and oxygen consumption, arterial and hepatic venous blood pressure, and heart rate. The intravenous administration of propranolol (0.13 mg/kg) was followed by significant reductions in splanchnic blood flow and oxygen consumption, in cardiac output and in heart rate. Splanchnic perfusion pressure was unchanged; the splanchnic vascular resistance was significantly elevated. Previous treatment with glucose did not alter these findings. Phenoxybenzamine prerreatment lessened the increase in splanchnic vascular resistance which propranolol ordinarily caused. Ganglionic blockade with hexamethonium prevented all of the changes which propranolol produced in untreated individuals. These results may best be explained by assuming that the splanchnic circulation in man is influenced both by a receptors, which cause vasoconstriction when activated, and by /9 receptors, which when activated cause vasodilatation and increase oxygen consumption.ADDITIONAL KEY WORDS alpha-adrenergic receptor blockade splanchnic vascular resistance beta-adrenergic receptor blockade propranolol hexamethonium splanchnic oxygen consumption phenoxybenzamine• One of us has reported (1) that the administration of propranolol (a /3-adrenergic receptor blocking drug of high specificity) to human subjects anesthetized with cyclopropane caused a marked reduction in splanchnic blood flow. This reduction resulted from increased vascular resistance and was usually accompanied by a diminution in local oxygen consumption. Since cyclopropane is believed to increase the impulse frequency in sympathetic nerves supplying the abdominal viscera (2), these observations raised the question whether some of the activity
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