Morbidity and mortality associated with anaesthesia

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. (C) Acta Anaesthesial Scandinavica 40 (1996).