Deaths during general anesthesia: technology-related, due to human error, or unavoidable? An ECRI technology assessment.

More than 2,000 healthy Americans die each year during general anesthesia, and at least half of these deaths may be preventable. Anesthetists and equipment manufacturers have made considerable progress in improving anesthesia safety. However, much more needs to be done, especially in "human-factors" areas such as improved training, consistent use of preanesthesia checklists, and anesthetists' willingness to enhance their vigilance by using appropriate monitoring equipment. While defective equipment and supplies are the direct cause of relatively few deaths, inexpensive oxygen analyzers and disconnect alarms could, if available in more ORs, warn anesthetists in time to convert many deaths to near misses. Some anesthetists are using other monitoring technologies that are more costly, but can detect a wider range of problems. The anesthesia community could expand its anesthesia-safety leadership and guidance, by improving technology-related training and by developing practice standards for anesthetists and safety standards for equipment. The Joint Commission on Accreditation of Hospitals could impose specific safety requirements on hospitals; malpractice insurance carriers could require anesthetists and hospitals to use monitors and alarms during all procedures; and the Food and Drug Administration could actively stimulate and oversee these efforts and perhaps provide seed money for some of them. The necessary equipment costs would likely be offset by long-term savings in malpractice premiums, as anesthesia incidents are the most costly of all types of malpractice claims. Concerted efforts such as these could greatly reduce the number of avoidable anesthesia-related deaths.