Pathological investigation of deaths following surgery, anaesthesia, and medical procedures

We were concerned to find that Start and Cross's otherwise comprehensive Best Practice artcle on the investigation of medical accidents1 failed to discuss the investigation of possible anaphylactic reactions. Fatal anaphylaxis can occur during approximately 1/100 000 general anaesthesia administrations. Anaphylactoid reactions, where IgE mediated allergy is not involved in reactions to—for example, contrast media, account for a further number of deaths. In some instances, an anaphylactic reaction might be obvious and postmortem examination may simply confirm the cause of death. In many other …