This was an independent retrospective audit study conducted by two clinical nurse specialists, with educational support by Activa Healthcare to assist in bringing it to print.

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.

No abstract

TOTAL HIP REPLACEMENT has become a frequent procedure since the initial work of Charnley, McKee, Watson, Ferrar and Ring in the early 1960s. The most popular technique, that of Miiller, ~ involves a socket prosthesis fixed in the acetabulum with acrylic bone cement. A femoral prosthesis is then fixed in the medullary cavity with the same acrylic cement. Peroperative complications associated with prosthesis implantation have ranged from transient hypotension, 8 cardiac arrest, 4 and embolic phenomena TM to significant decreases in arterial oxygen tension, s,9 This study is an attempt to review the clinical management of these patients with particular attention to their needs during operation. An attempt is also made to assess the significance of variations of the cardiovascular and pulmonary gas exchange which are associated with the use of acrylic bone cement. Alveolararterial oxygen gradients (A-aDO2), arterio-alveolar carbon dioxide gradients (a-ADCO2), and venous admixture (Qs/Qt) are used to assess these variations.