Anesthesia in 1984: how safe is it?

The methods of gathering information to determine the safety of anesthesia and to establish the risk of mortality and morbidity include anecdotal tales, in-hospital audit and peer review, reports to medical protective societies, retrospective studies, reviews of specific problems and prospective studies. All these methods have limitations and, in particular, do not readily differentiate the anesthetic from the surgical contributions. However, it appears that over the past 30 years the risk of death directly attributable to anesthesia has decreased from 1 in 2680 to about 1 in 10 000. The main causes of death are faulty anesthetic techniques due to human error, drug overdose, coexistent disease and failure of immediate postoperative care. Equipment failure, poor preoperative assessment, halothane-associated hepatitis and malignant hyperthermia, although often cited in the literature, are rarely the cause of problems associated with anesthesia.