Morbidity and Mortality from Anesthesia

Anesthetic exposure is usually necessary but rarely sufficient to the conduct of therapy. Consequently, there is a natural abhorrence of any worsening of a patient's condition secondary to the administration of anesthesia, which offers the patient no direct benefit. Highly safe anesthesia is a necessary precondition for the application of most surgical treatment, and the diversity of modern surgery provides support for the relative safety of contemporary anesthetic practice. The question arises as to whether this general sense of confidence is illusory. If current estimates are accurate, mortality rates associated with anesthesia may be 2000 patients each year in the United States alone. One assumes the correctness of the premise that errors of performance or malfunction of the anesthetic human-machine "system," rather than ignorance of the relevant biology, account for the great majority of untoward outcomes. If this is the case, examination of the critical incidents involved in anesthesia should provide some helpful guidance. The data of Cooper et al. show that the maintenance period of anesthesia is the time of the largest single number of critical incidents.