A prospective survey of anaesthesia-related mortality and morbidity in infants and children was carried out in a representative sample of anaesthetics performed in 440 institutions chosen at random in France. A total of 40240 anaesthetics were administered to patients younger than 15 yr, 2103 (5%) involving infants (younger than 1 yr). Twenty-seven major complications related to anaesthesia occurred during or within 24 h of the anaesthesia--an incidence of 0.7 per 1000 anaesthetics. Nine, of which four were associated with cardiac arrest, were observed in infants, whereas in children there were 18 complications of which eight were associated with cardiac arrest, one with fatal outcome. The risk of complications was significantly higher (P less than 0.001) in infants (4.3 per 1000) than in children (0.5 per 1000). Accidents observed in infants mainly occurred during maintenance of anaesthesia and were the result of respiratory failure. In children, circulatory failure was as frequent as respiratory failure and complications were observed almost equally during induction and maintenance and on recovery. The rate of complications increased significantly with the ASA score and the number of co-existing diseases. The incidence was also higher when a previous history of anaesthesia was present, when the procedure was an emergency, and when the duration of preoperative fasting was less than 8 h.

A prospective survey of complications associated with anaesthesia was carried out in France from 1978 to 1982 in a representative sample of 198,103 anaesthetics performed in 460public and private institutions chosen at random in the country as a whole. There were 268 major complications associated with anaesthesia occurring during or within 24 hours of anaesthesia (one per 739 anaesthetics), among which 67 were followed by death within 24 hours and 16 by coma persistent after the 24th hour. The incidence of death and coma was one per 2387 anaesthetics. The incidence of death and coma totally attributable to anaesthesia was one per 7924 anaesthetics. Fifty-eight per cent of complications occurred during anaesthesia while 42 per cent were observed during the recovery period. Mortality was lower following complications during anaesthesia than for those during the recovery period. Half of the deaths and cases of coma totally attributable to anaesthesia were due to postanaesthetie respiratory depression. The rate of complications appeared to be dependent upon several risk factors: the patient' s age, the number of assoclated diseases, the pre-operative status, whether the operation was an emergency and the duration of procedure.

This paper reports the findings of a study of head trauma conducted over a one-year period within a defined region with a population of 2.7 million (Aquitaine, France). It includes cases resulting in death prior to hospitalization or requiring hospitalization. During the one-year period, 391 deaths and 8549 hospital admissions due to head trauma occurred, yielding an annual estimate of 8940 head-injured people. The immediate case-fatality rate was 4.4%. Among non-fatal cases, 80% were mild, 11% moderate and 9% severe. The overall annual incidence was 281/100,000 in both sexes (384 and 185/100,000 in males and females respectively). The annual death rate was 22/100,000 (33 and 12, respectively). Patterns of incidence by age and sex were in general agreement with earlier studies. The main causes of head trauma were traffic accidents (60%) and falls (33%). One-third of hospitalized patients had no injury other than the head trauma. The most frequently associated injuries were those involving extremities, whereas the most severe were those involving the abdomen. The Injury Severity Score (ISS) ranged from 4 to 66, with a mean of 9 and a median of 5. At the eighth day following injury, 25% of hospital-treated patients were still hospitalized and 2% had died. The outcome correlated well with the ISS.

Although maternal mortality is higher in France than in other European countries, hospital data prove that maternal deaths are underestimated. To assess the degree of underestimation and investigate the reasons for it, a retrospective survey was carried out among the certifying doctors of the 3045 deaths that occurred among women aged 15-44 years, from December 1988 to March 1989. Doctors were asked for information on the obstetric condition of the women and their health before death. Some 88.2% of those approached responded. Sociodemographic information was obtained from the French national record of causes of death. Although doctors reported gravid puerperal conditions on 41 death certificates, only 24 deaths were classified in the maternal mortality category of the International Classification of Diseases. The other 17 deaths were classified elsewhere. The present survey permitted the identification of 27 additional deaths of which 16 were considered as having obstetric causes. Of the 68 deaths in pregnant or puerperal women which occurred during the survey period, 54 were classified as having obstetric causes. No sociodemographic differences were found between the deaths registered in the national record and the newly identified maternal deaths. All deaths occurring during or after parturition were reported to the national record, but most of the deaths from abortion were identified from the survey. The discussion deals with the misclassification of maternal deaths and the difficulty of determining the underlying cause of deaths involving complex diseases or uncertain pathogenesis.

The prediction of outcome of anaesthesia in patients over 40 years of age was assessed using a multifactorial index based on current preoperative factors recorded prospectively. The study was conducted using a representative sample of anaesthetizations (except for cardiac surgery) including 517 cases with major complication (occurring during or within 24 hours of anaesthesia) and a one in fifty random sample comprising 1538 cases without complication. A split sample approach was adopted and a logistic regression model was applied to two subsets of similar size. Four preoperative factors were significantly associated with the occurrence of complications: ASA physical status, age, surgical procedure (major/minor) and type (elective/emergency). Goodness-of-fit of the model was assessed using another sample of 332 cases with complication and a different subset of 987 cases without complication. The model fitted the data well (p = 0.15).