Most U.K. deaths under anaesthetic ‘avoidable’

Press, 28 August 1982, Page 24

Most U.K. deaths under anaesthetic ‘avoidable’

NZPA London A report compiled by senior British anaesthetists suggests that bad anaesthetic techniques may cost up to 900 lives a year. A team of assessors has reviewed anaesthetic safety by investigating all the deaths associated with surgery in a representative, third of Britain. The survey, published by the Nuffield Provincial Hospitals Trust, for the Association of Anaesthetists, concludes- that although an anaesthetic is usually safe, one in 10,000 patients dies directly as a result of it. In Britain, this represents about 280 a year; the authors feel that most of these deaths were avoidable. In a further 1800. cases of death after surgery, anaesthesia was thought to be partly responsible, and avoidable. Faulty anaesthetic practice was considered to be a serious factor in 600 of the fatalities. • The New Zealand Anaesthetic Mortality Review Committee had been functioning for only three years and no reliable figures were yet available, said the chairman of anaesthetic services for the North Canterbury Hospital Board, Dr D. I. Chisholm. He estimated that 200,000 operations were performed under anaesthetic each year. “It worries me when people think that the situation is getting worse when in fact it is getting much better. ,We take on things no\y that 'we’ would not have dreamed-of doing 30

years ago,” Dr Chisholm said. The mortality rate under anaesthetic had dropped sharply, he said. The report said that mistakes were made by all grades of anaesthetists but trainee anaesthetists were often inadequately supervised. New Zealand anaesthetists were all qualified doctors and normally those working for the North Canterbury Hospital Board worked alongside a senior consultant, under a training programme, Dr Chisholm said. Ten per cent of patients in the British survey were not examined by the anaesthetist before their operations, which meant that 300,000 patients in Britain were anaesthetised each year without first meeting theiranaesthetist. Even when they did meet, the doctor sometimes tended to under-estimate the effect of other diseases, particularly coronary heart disease, from which the patient might be suffering, and therefore failed to take the necessary precautions. '' Dr Chisholm said that it was board policy for all patients to be interviewed by the anaesthetist before surgery but this was not always possible.

“When it is. a Sunday morning and there is a whole string of acute cases brought to the front door half dead we cannot always interview them. We just want to do something for them as quickly as possible.” The authors of the British report felt that at the very

least all patients should have their blood pressure and electrocardiographs (heart tracings) monitored during anaesthesia, but 4.4 per cent of patients who subsequently died had no monitoring and only 57 per cent of patients had an E.C.G. in position during the surgery. E.C.G.s were not always used on Christchurch patients but all had their blood pressure • monitored and some form T of electronic monitoring. “We would apply an E.C.G. when operating on someone with a rocky heart but not-on an 18-year-old youth having surgery on a finger,” said Dr Chisholm. The report said that in 17.8 per cent of . fatal cases, the. anaesthetic machine was not tested before the patient was anaesthetised.

Dr Chisholm said that all North Canterbury Hospital Board machines were checked before use and were on a continuous maintenance and overhaul programme. The report concluded that the fatal bases were a small fraction of the three million anaesthetics given in Britain every year, but the authors felt that when considered in isolation the numbers were large. They sum up: “There is probably a rate below which even superhuman, efforts will not achieve improvements, but it would be difficult or impossible to estimate what that rate is. There is . sufficient evidence inithis report to suggest that the death rate involving anaesthesia has not yet fallen to this low level.” • . ,