• William Clayton Petty, Michael Kremer, and Chuck Biddle.
• Rush University Nurse Anesthesia Program, Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill., USA.
• AANA J. 2002 Jun 1;70(3):193-202.

AbstractThe study of anesthesia risk is fraught with methodological challenges and the epidemiological uncertainty peculiar to anesthesia: the true frequency of anesthetic mortality is unknown. If anesthesia mortality is as rare as 1 in 200,000 cases, the sample needed to study this phenomenon would be enormous. Existing studies provide insights to the genesis of damaging events and adverse outcomes in anesthesia. We examined research design, methodology, and findings to date in 3 studies of anesthesia risk. Limitations include self-report by providers in the Australian study and the retrospective nature of closed claims research in American studies. Respiratory events were the largest class of injury in all 3 studies; substandard care frequently was involved. Australian investigators noted a high rate of human error and equipment issues. American physician investigators found that death or brain damage occurred in 85% of respiratory cases, 72% of which were deemed preventable. Nurse anesthetist investigators had similar findings for respiratory claims. Patient acuity and procedure complexity may be less significant contributory factors to anesthesia risk than are provider vigilance and clinical decision making. Prospective multicenter studies conducted politically may be the only type of research that definitively addresses the myriad issues in anesthesia risk research.

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