Canadian Journal of Anesthesia, Vol 27, 159-163, Copyright © 1980 by Canadian Anesthesiologists' Society

Death Within 48 Hours of Anaesthesia at the Vancouver General Hospital

¹ Department of Anaesthesia, University of British Columbia at Vancouver General Hospital

A formal review of all deaths within 48 hours of an anaesthetic is done at the Vancouver General Hospital. All cases are reviewed for significant contributory factors directly attributable to anaesthesia. This study presents the data of such a review of 195,232 anaesthetics administered between 1973 and 1977. The overall incidence of 2.2 deaths per 1000 anaesthetics compares favourably with other studies. The death classification system revealed a group of patients who were high risk and who could be classified as congenital heart disease, adult cardiacs with cardiopulmonary bypass, brain tumour or brain oedema, multiple injury, profound sepsis and major vascular catastrophies. Another group of patients were classified as possibly preventable deaths, as these patients had predictable respiratory and cardiac factors that could be anticipated and ameliorated. Careful attention to the essential principles of anaesthetic care such as careful preoperative assessment, adequate patient monitoring and access to the patient (e.g. intravenous, precordial stethoscopes), supportive recovery room and intensive care unit care and a continuing assessment and review of each anaesthetic-related death, have helped to decrease the number of deaths in this patient group.

The final assessment of patients who have had an anaesthetic should assure adequacy of respiratory function, tissue perfusion, central nervous system function and tissue oxygenation. Such an approach should result in a minimum of deaths within 48 hours of anaesthesia.