5 - Deaths following anaesthesia: lessons from NCEPOD

Summary

Death is the ultimate unfavourable outcome after anaesthesia. The first anaesthetic death has been reported as that of Alexis Montigny in Auxerre on 10th July 1847 from respiratory obstruction owing to the administration of ether. Deaths such as this that are directly caused by the anaesthetic process (‘direct anaesthetic deaths’) are obviously of great concern but deaths where anaesthetic factors contribute to a patient's death in combination with factors related to the patient's condition and to the surgery (‘anaesthetic-related deaths’) are equally important. Anaesthetic-related deaths are more common, so improvements in this area will have the greater impact on the overall burden of morbidity and mortality.

Anaesthetic mortality rate

Studies of the rates of death following anaesthesia have two uses. Patients perceive anaesthesia to be inherently dangerous and want to know the risks of dying under anaesthesia: conversely anaesthetists want to know about mortality rates to defend themselves against unwarranted attacks on the safety of their specialty. Secondly anaesthetists need repeated studies on anaesthetic mortality to measure whether efforts to improve anaesthetic safety have borne fruit. There have been many studies of anaesthetic mortality over the last 50 years. Unfortunately comparisons between studies are problematic. The definition of an anaesthetic death, the time period within which the patient died, the classification of the extent of anaesthetic involvement in the patient's death and the type of study population all vary from one study to another.