The Special Committee Investigating Deaths Under Anaesthesia (SCIDUA) reviews all deaths under or within 24 h of anaesthesia in the Australian state of New South Wales, with a population of 5.7 million. The Committee is appointed by the Minister for Health, is legally privileged and provides complete confidentiality of its investigations. Deaths are reported to SCIDU by the State Coroner's Office. The anaesthetist involved in each case then is asked to complete and voluntarily return a questionnaire on the event. There is a 92% response rate.In reviewing 1503 deaths in approximately 3.5 million surgical procedures between 1984 and 1990, the Committee concluded that factors under the control of the anaesthetist caused or significantly contributed to the deaths of 172 patients. No better alternative procedure was available in 11 of the cases and, in these, the procedure was carried out properly. The findings demonstrate a rate of one anaesthesia related death in 20 000 operations, compared with 1:5500 in 1960 and 1:lO 250 in 1970.In children under ten years of age, there were 76 deaths investigated, with approximately 280 000 operations in this age group. sixty-three percent of the children were less than one year. The operations involved were chiefly cardiothoracic, laparotomies for necrotising enterocolitis in premature neonates and trauma surgery. Anaesthetic factors were implicated in only one of the 76 deaths.While there are limitations to the study, in its 34 years SCIDUA has provided a credible estimate of anaesthesia related mortality and been able to highlight features of its incidence and pattern. The major anaesthetic factors relating to the deaths remain inadequate pre-and postoperative care, inappropriate choice of anaesthetic technique or drugs and overdosage with anaesthetic agents.

The New South Wales Special Committee Investigating Deaths Under Anaesthesia classified 1503 deaths before full recovery from anaesthesia occurring between 1984 and 1990. 172 deaths were attributed to anaesthesia, including 11 in which the anaesthetic choice or management could not be criticized. In the remaining 161 an average of 1.8 errors per case were identified, the most frequent being inadequate preparation of the patient (in 72 cases), inadequate postoperative care (52 cases), the technique of anaesthesia chosen (44 cases) and overdose (43 cases). Death was most commonly attributed to anaesthesia in elderly patients (modal age group 70–79), in males (1.9:1) and was most commonly associated with abdominal and orthopaedic operations. Urgent non-emergency cases, 10% of the 1503 cases classified, constituted 26% of those deaths attributed to anaesthesia. One death attributable to anaesthesia occurred per 20,000 operations and the rate of such deaths was 0.44 per 100,000 population per annum.

The haemodynamic responses to minimum equipotent concentrations of halothane and enflurane were compared in seven dogs. The haemodynamic responses to increasing concentrations of enflurane, and to induced hypovolaemia during enflurane anaesthesia, were studied in the same dogs, both before and after administration of propranolol 0.3 mg kg-1 i.v. In equipotent concentrations, enflurane caused marginally greater impairment of left ventricular function than halothane, and caused a dose-dependent reduction of arterial pressure, cardiac output and myocardial contractility. Following administration of propranolol, these haemodynamic effects of enflurane were marked, and withdrawal of 20% of estimated blood volume was tolerated poorly.

The Special Committee Investigating Deaths Under Anaesthesia (SCIDUA) reviews all deaths under or within 24 h of anaesthesia in the Australian state of New South Wales, with a population of 5.7 million. The Committee is appointed by the Minister for Health, is legally privileged and provides complete confidentiality of its investigations. Deaths are reported to SCIDU by the State Coroner's Office. The anaesthetist involved in each case then is asked to complete and voluntarily return a questionnaire on the event. There is a 92% response rate.In reviewing 1503 deaths in approximately 3.5 million surgical procedures between 1984 and 1990, the Committee concluded that factors under the control of the anaesthetist caused or significantly contributed to the deaths of 172 patients. No better alternative procedure was available in 11 of the cases and, in these, the procedure was carried out properly. The findings demonstrate a rate of one anaesthesia related death in 20 000 operations, compared with 1:5500 in 1960 and 1:lO 250 in 1970.In children under ten years of age, there were 76 deaths investigated, with approximately 280 000 operations in this age group. sixty-three percent of the children were less than one year. The operations involved were chiefly cardiothoracic, laparotomies for necrotising enterocolitis in premature neonates and trauma surgery. Anaesthetic factors were implicated in only one of the 76 deaths.While there are limitations to the study, in its 34 years SCIDUA has provided a credible estimate of anaesthesia related mortality and been able to highlight features of its incidence and pattern. The major anaesthetic factors relating to the deaths remain inadequate pre-and postoperative care, inappropriate choice of anaesthetic technique or drugs and overdosage with anaesthetic agents.