Deaths Under Anæsthetics

Macintosh, R. R.

doi:10.1093/bja/21.3.107

Cited by 68 publications

(23 citation statements)

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“…Although anesthesia-related mortality has been reduced in recent decades, such a reduction is insufficient because, as articulated by Macintosh in 1948,36 the ideal goal is that zero anesthesia-related deaths should occur. Unfortunately, anesthesia still contributes to major and avoidable adverse effects and deaths,37–39 and is still not completely safe in ASA I or II status patients 3…”

Section: Discussionmentioning

confidence: 99%

Mortality in Anesthesia: A Systematic Review

Braz

Cruz

et al. 2009

Clinics

115

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This systematic review of the Brazilian and worldwide literature aims to evaluate the incidence and causes of perioperative and anesthesia-related mortality. Studies were identified by searching the Medline and Scielo databases, followed by a manual search for relevant articles. Our review includes studies published between 1954 and 2007. Each publication was reviewed to identify author(s), study period, data source, perioperative mortality rates, and anesthesia-related mortality rates. Thirty-three trials were assessed. Brazilian and worldwide studies demonstrated a similar decline in anesthesia-related mortality rates, which amounted to fewer than 1 death per 10,000 anesthetics in the past two decades. Perioperative mortality rates also decreased during this period, with fewer than 20 deaths per 10,000 anesthetics in developed countries. Brazilian studies showed higher perioperative mortality rates, from 19 to 51 deaths per 10,000 anesthetics. The majority of perioperative deaths occurred in neonates, children under one year, elderly patients, males, patients of ASA III physical status or poorer, emergency surgeries, during general anesthesia, and cardiac surgery followed by thoracic, vascular, gastroenterologic, pediatric and orthopedic surgeries. The main causes of anesthesia-related mortality were problems with airway management and cardiocirculatory events related to anesthesia and drug administration. Our systematic review of the literature shows that perioperative mortality rates are higher in Brazil than in developed countries, while anesthesia-related mortality rates are similar in Brazil and in developed countries. Most cases of anesthesia-related mortality are associated with cardiocirculatory and airway events. These data may be useful in developing strategies to prevent anesthesia-related deaths.

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Section: Discussionmentioning

confidence: 99%

Mortality in Anesthesia: A Systematic Review

Braz

Cruz

et al. 2009

Clinics

115

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“…When reviewing the literature of the last 50 years on studies of anaesthesia related morbidity and mortality it is remarkable how the same complications continue to happen. In the 1940's MacIntosh described problems of airway management, lack of monitoring and inadequate supervision (4). Two generations later numerous studies cite the problems of failure to ventilate, human error, lack of vigilance and poor supervision!…”

Section: Severe Anaesthesia Complicationsmentioning

confidence: 99%

“…Critical incident analysis techniques have con-firmed the prevalence of potential hypoxic incidents and also identified other areas of concern such as equipment failure, aspiration of gastric contents and inappropriate drug dosage. Several authors have highlighted the fact that most accidents stem from human error (4,10,14,16,21,23,29,31,33,39). Many equipment "failures" could have been detected by a competent pre-use check.…”

Section: Critical Incident Analysis -Risk Factorsmentioning

confidence: 99%

Morbidity and mortality associated with anaesthesia

Sigurdsson

McAteer

1996

Acta Anaesthesiol Scand

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The incidence of serious complications associated with Anaesthesia appears to have decreased in recent years. There are many reasons for this—better anaesthetic drugs and equipment, widespread availability of modern monitoring devices, improved standards of pre‐, intra‐ and postoperative care, increasing interest in techniques to identify and control common risk factors and increased number of qualified anaesthetists. Nevertheless, accidents continue to occur. The most common cause of death or serious injury is still failure to ventilate the patient. All recent studies agree that the majority of accidents in modern practice are the consequence, not of equipment failure or adverse drug reactions, but of human error. Mistake, lack of vigilance, inexperience, inadequate supervision and failure of communication are identified as recurring problems. These problems need to be addressed if anaesthesia‐related complications are to be further decreased. It seems reasonable to suggest that the use of anaesthesia simulators to train and test anaesthetists in difficult situations should be given a higher priority—both in basic training and in continued postgraduate education. Furthermore, since anaesthesia‐related adverse outcomes are rare, strict safety procedures must be applied to thousands of patients in order to prevent one catastrophe. During times of increasing competition for health care money, anaesthetists must be resolute in defending and improving standards of training, monitoring and clinical care. Otherwise the substantial improvement in anaesthesia practice accomplished over recent years may quickly be lost again.

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“…Pre‐operative fasting has been a matter of some controversy ever since James Simpson, in 1842, blamed aspiration of brandy for the first death under a chloroform anaesthetic [1]. Whilst aspiration has been long established as an important cause of morbidity and mortality [2], the origins of prolonged pre‐operative fasting remain unclear [3]. More recently a number of groups have shown that patients may be fasted for as little as 2 h for clear fluids and 6 h for solids including milk, with no adverse effect on gastric contents [4, 5].…”

Section: Introductionmentioning

confidence: 99%

Pre-operative fasting and administration of regular medications in adult patients presenting for elective surgery. Has the new evidence changed practice?

Pearse

Rajakulendran

1999

Eur J Anaesthesiol

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Several studies have demonstrated that pre-operative fasting may be as short as 2 h for clear fluids and 6 h for solids with no adverse effect on volume or pH of gastric contents. Other studies suggest that many patients do not receive pre-operative prescribed medications. One hundred and fifty-three adults presenting for elective surgery (mean age 51 years) were studied to assess fasting practice. Fasting times far in excess of the recommended safe minimum were found. Mean length of fast for solids was 15 h 24 min (95% confidence intervals +/- 49 min) and for fluids 12 h 30 min (95% confidence intervals +/- 30 min). Of the 53 patients taking regular medications, 23 did not receive one or more drugs pre-operatively; most notably 45% of cardiac prescriptions were not administered. Despite strong evidence to support a change, actual practice continues to fall below accepted standards.

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Deaths Under Anæsthetics

Cited by 68 publications

References 0 publications

Mortality in Anesthesia: A Systematic Review

Mortality in Anesthesia: A Systematic Review

Morbidity and mortality associated with anaesthesia

Pre-operative fasting and administration of regular medications in adult patients presenting for elective surgery. Has the new evidence changed practice?

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