Safe anesthesia: some general considerations.

Most of the articles on safety in anesthesia take the mortality as the criterion. This is fallacious. The anesthetist's area of responsibility must be clearly defined before his contribution to any given mortality can be assessed. The development of the field of anesthesiology has extended this area enormously. As a result, the techniques employed and the results obtained need to be reviewed and reconsidered. Outdated attitudes must be resolutely abandoned, particularly with regard to monitoring. The use of a coding system for anesthetic complications helps towards an objective assessment of the degree of safety achieved. The results obtained by this means in the Institute of Anesthesiology in Utrecht are reported.