A prospective analysis of critical incidents attributable to anaesthesia.

The purpose of the study was an accurate and comprehensive prospective analysis of all untoward anaesthetic events and their sequelae, within a general hospital over a period of 1 year. We identified five system sets into which each of these critical incidents could be categorised. We also recorded data pertaining to the severity of the disturbance or event, the monitor that first identified the problem and the affect, if any, of the incident upon the patient. We found a critical incident rate of 6.68%, or one in 15 anaesthetic procedures performed. By far the majority of incidents were rapidly detected and effectively managed, with a morbidity rate of only 0.53%. The application of minimum monitoring standards was strongly reinforced. The presence of an anaesthetist throughout the period of the whole anaesthetic was shown to be the most effective component of these standards. The audit identified a trend for junior anaesthetists in particular to have a higher incidence of problems with the airway and circulation and for these to be associated with increased morbidity. This prompted revised supervision and training strategies for our junior anaesthetists.