Skip to main content Accessibility help
×
Hostname: page-component-76fb5796d-25wd4 Total loading time: 0 Render date: 2024-04-29T14:32:17.032Z Has data issue: false hasContentIssue false

5 - Deaths following anaesthesia: lessons from NCEPOD

Published online by Cambridge University Press:  15 December 2009

Anthony Gray
Affiliation:
Department of Anaesthesia Norfolk and Norwich University Hospital Colney Lane Norwich NR4 7UY UK
Jeremy Cashman
Affiliation:
St George's Hospital, London
Michael Grounds
Affiliation:
St George's Hospital, London
Get access

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.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adams, N. The first anaesthetic deaths. CPD Anaesthesia 1999; 1: 142–6.Google Scholar
White S. Risks associated with your anaesthetic. Section 14: Death or brain damage. 2006. Royal College of Anaesthetists. Available from http://www.rcoa.ac.uk/docs/death%20or%20brain%20damage.pdf.
Buck, N, Devlin, HB, Lunn, JN (eds). The Report of the Confidential Enquiry into Perioperative Deaths. London: The Nuffield Provincial Hospitals Trust/Kings Fund 1987.Google Scholar
Gaba, DM. Anaesthesiology as a model for patient safety in health care. BMJ 2000; 320: 785–8.CrossRefGoogle ScholarPubMed
Gibbs, N, Rodoreda, P. Anaesthetic mortality rates in Western Australia. Anaesth Intensive Care 2005; 33: 616–22.Google ScholarPubMed
Edwards, G, Morton, HJV, Pask, EA, Wylie, WD. Deaths associated with anaesthesia. A report on 1,000 cases. Anaesthesia 1956; 11: 194–220.CrossRefGoogle ScholarPubMed
Braz, LG, Módolo, NSP, Nascimento, P Jr, et al. Perioperative cardiac arrest: a study of 53 718 anaesthetics over 9 years from a Brazilian teaching hospital. Br J Anaesth 2006; 96: 569–75.CrossRefGoogle Scholar
Arbous, MS, Grobbee, , Kleef, JW, et al. Mortality associated with anaesthesia: a qualitative analysis to identify risk factors. Anaesthesia 2001; 56: 1141–53.CrossRefGoogle ScholarPubMed
Biboulet, P, Aubas, P, Dubourdieu, J, et al. Fatal and non-fatal cardiac arrests related to anesthesia. Can J Anesth 2001; 48: 326–32.CrossRefGoogle ScholarPubMed
Eichhorn, JH. Prevention of intra-operative anesthesia accidents and related severe injury through safety monitoring. Anesthesiology 1989; 70: 572–7.CrossRefGoogle Scholar
Lagasse, RS. Anesthesia safety: model or myth?Anesthesiology 2002; 97: 1609–17.CrossRefGoogle ScholarPubMed
Cooper, JB, Gaba, D. No myth: anesthesia is a model for addressing patient safety (editorial). Anesthesiology 2002; 97: 1335–7.CrossRefGoogle Scholar
NCEPOD. Functioning as a Team? The 2002 report of the National Confidential Enquiry into Perioperative Deaths. London: NCEPOD, 2002. www.ncepod.org.uk
NCEPOD. Extremes of Age. The 1999 report of the National Confidential Enquiry into Perioperative Deaths. London: NCEPOD, 1999. www.ncepod.org.uk
NCEPOD. Abdominal Aortic Aneurysm: A Service in Need of Surgery? London: NCEPOD, 2005. www.ncepod.org.uk
Birkmeyer, JD, Siewers, AE, Finlayson, EVA, et al. Hospital volume and surgical mortality in the United States. N Engl J Med 2002; 346: 1128–37.CrossRefGoogle ScholarPubMed
Birkmeyer, JD, Stukel, TA, Siewers, AE, et al. Surgeon volume and operative mortality in the United States. N Engl J Med 2003; 349: 2117–27.CrossRefGoogle ScholarPubMed
Kahn, JM, Goss, CH, Heagerty, PJ, et al. Hospital volume and the outcomes of mechanical ventilation. N Engl J Med 2006; 355: 41–50.CrossRefGoogle ScholarPubMed
Pearse, RM, Dana, EC, Lanigan, CJ, Pook, JAR. Organisational failures in urgent and emergency surgery. Anaesthesia 2001; 56: 684–9.CrossRefGoogle ScholarPubMed
Dyer, C. Hospital trust prosecuted for not supervising junior doctors. BMJ. 2006; 332: 135.Google Scholar
NCEPOD. An acute problem? London: NCEPOD, 2005. www.ncepod.org.uk
NCEPOD. Changing the way we operate. The 2001 report of the National Confidential Enquiry into Perioperative Deaths. London: NCEPOD, 2001. www.ncepod.org.uk
Fletcher, SN, Kennedy, DD, Ghosh, IR, et al. Persistent neuromuscular and neurophysiologic abnormalities in long-term survivors of prolonged critical illness. Crit Care Med 2003; 31: 1012–16.CrossRefGoogle ScholarPubMed
Gordon, SM, Jackson, JC, Ely, EW, Burger, C, Hopkins, RO. Clinical identification of cognitive impairment in ICU survivors: insights for intensivists. Intens Care Med. 2004; 30: 1997–2008.CrossRefGoogle ScholarPubMed
Dowdy, DW, Eid, MP, Sedrakyan, A, et al. Quality of life in adult survivors of critical illness: A systematic review of the literature. Intens Care Med 2005; 31: 611–20.CrossRefGoogle ScholarPubMed
General Medical Council. Good Medical Practice. London: GMC, 2006. www.gmc-uk.org
Meiler, SE. Long-term outcome after anaesthesia and surgery: remarks on the biology of a newly emerging principle in perioperative care. Anesthesiology Clin N America 2006; 24: 255–78.CrossRefGoogle ScholarPubMed
Podgoreanu, MV, Schwinn, DA. New paradigms in cardiovascular medicine: emerging technologies and practice – perioperative genomics. J Am Coll Cardiol 2005; 46: 1965–77.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×