A formal review of all deaths within 48 hours of an anaesthetic is done at the Vancouver General Hospital. All cases are reviewed for significant contributory factors directly attributable to anaesthesia. This study presents the data of such a review of 195,232 anaesthetics administered between 1973 and 1977. The overall incidence of 2.2 deaths per 1000 anaesthetics compares favourably with other studies. The death classification system revealed a group of patients who were high risk and who could be classified as congenital heart disease, adult cardiacs with cardiopulmonary bypass, brain turnour or brain oedema, multiple injury, profound sepsis and major vascular catastrophics. Another group of patients were classified as possibly preventable deaths, as these patients had predictable respiratory and cardiac factors that could be anticipated and ameliorated. Careful attention to the essential principles of anaesthetic care such as careful preoperative assessment, adequate patient monitoring and access to the patient (e.g. intravenous, precordial stethoscopes), supportive recovery room and intensive care unit care and a continuing assessment and review of each anaestheticrelated death, have helped to decrease the number of deaths in this patient group.The final assessment of patients who have had an anaesthetic should assure adequacy of respiratory function, tissue perfusion, central nervous system function and tissue oxygenation. Such an approach should result in a minimum of deaths within 48 hours of anaesthesia. ADVANCES IN ANAES'FHETIC TECHNIQUES haveallowed the scope of surgical procedures to increase dramatically. The practicing anaesthetist is faced with a widcr range of problems spanning the extremes of age. The primary role of the anaesthetist includes the traditional objectives of the provision of amnesia, analgesia, reflex control and relaxation with the addition of oxygenation and tissue perfusion. The anaesthetist must ensure the safety of the patient under his care. He must do his utmost to ensure the patient survives the anaesthetic and the postoperative period. The information yielded by a study of deaths associated with anaesthesia will provide the anaesthetist with data that review, support or question the techniques he uses. Such a review should form a part of every anaesthetist's selfappraisal system.The Mortality Review Committee of the Department of Anaesthesia at the Vancouver General Hospital formally reviews every dcath occurring within 48 hours of an anaesthetic. Particular attention is paid to anaesthetic charts and any contributory role of anaesthesia in the circumstances of a patient's death.

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