Perioperative and anesthetic deaths: toxicological and medico legal aspects

Abstract

Background: Anesthesia has become safer during decades, though there is still a preventable mortality; the complexity of medical and surgical interventions, increasingly older and sicker patients, has created a host of new hazards in anesthesiology. In this paper, some of these perioperative (PO) fatal adverse events are investigated in terms of health responsibility. Selective literature research in several data bases, concerning perioperative and anesthetic deaths and medical responsibility, was performed. Main text: A generally accepted definition of the anesthesia and perioperatory-related death still remains one of the major concerns in forensic pathology, and the terms "operative deaths" and "anesthetic deaths" are usually applied inaccurately within the medico-legal literature. Such events involve comprehensively PO fatalities and allow for subtle separation of natural and unnatural death, at least from the prospective of forensic pathology. Iatrogenic deaths in this field can be separated into some major categories, as attributable to previous patient's unfavorable conditions or depending from surgical procedure per se (such as PO cardiac and cerebrovascular events). In this review, the authors carried out syntheses of specific research areas regarding epidemiology, complications of general and spinal anesthetic, failure in airway management and patient's circulatory homeostasis, and adverse drugs reactions; analysis considering the challenge of anesthetic-related mortality, epidemiology and classifications, by indicating causal chain of death, in respect of both contributing and associated anesthetic and surgery facts. Conclusions: Perioperative quality control programs and its relevance for medico-legal evaluation are emphasized as, although mortality rates have decreased worldwide over the last decades, however, preventable drug-related deaths still happen. Such fatal events have to be considered within the field of forensic pathology experts, with regard of malpractice claims, to implement a strategy for preventing potentially fatal complications.

Anesthesia-Related Mortality in Children: A Surgeon’s Perspective

“…This finding is consistent with the report of Li et al and Pascal et al [1,11]. However, Argo et al found more anesthetic deaths in females [12]. The reason for the gender differences in anesthetic deaths is not known.…”

“…About half of the anesthesia-related mortality in the index study occurred in neonates. Disma et al also reported more mortality in neonates [12]. The reason for this may be because the fragile homeostasis of the neonate is adversely affected by the stress of surgery and anesthesia [14].…”

“…One study from Brazil also reported airway management as a common cause of anestheticrelated death in pediatric patients [4]. Airway problems encountered include complications of endotracheal intubation such as esophageal intubation or delays in intubation as seen in inexperienced anesthetists [12]. The most common of the endotracheal mishaps is unsuccessful intubation after muscle relaxant administration [18].…”

“…The most common of the endotracheal mishaps is unsuccessful intubation after muscle relaxant administration [18]. Other causes of airway problems are disconnection, dislodgement of the endotracheal tube, tube kinking, tube obstruction, bronchospasm, aspiration of vomitus and anatomic abnormalities [12]. The sequel of failed intubation is hypoxic-ischemic encephalopathy and brain death due to oxygen deficiency [19].…”

Anesthesia for the Elderly Patients Current Concepts and Review of the Literature

“… Associated sicknesses (e.g., pneumonic or renal) along with additional restriction in benchmark work and a modified neurohumoral reaction to push.  Increased occurrence of sudden responses to drugs, sedation and medical procedure [10].…”