by Dr. Ross Holland , Director of Anesthetics and Resuscitation,The Parramatta Hospitals Westmead, New South Wales, Australia

A striking difference has emerged in the profile of anesthesia techniques represented in cases reported to the NSW Mortality Committee during the 3 years from July 1, 1983, compared with the 20 years from 1960 1980.

Regional anesthesia, which was represented at a low level in the earlier years of this study, has increased markedly and now is used in over 20% of anesthesia-attributable mortality.

Likewise disproportionate representation of hip surgery appears in recent times. The death figures are as follows

	1960-1979	1983-85
Total anesthesia attributable deaths	575	51
Regional Anesthesia deaths and % of total	32 (5.6%)	12 (25%)
Hip Surgery deaths and % of total	29 (5%)	16 (32%)
Regional Anesthesia for hip surgery and % of hip deaths	3 (10%)	9 (56%)

The reasons for these dramatic changes are not obvious, but the NSW Committee believes that reluctance to use vasopressors, and excessive reliance on extracellular fluid expansion by crystalloid solutions are contributing to deaths in patients undergoing major regional blocks.

The Victorian Consultative Council on Mortality and Morbidity in anesthesia has published its second report, generating some controversy over certain statements made by the Council.

For instance, spontaneous ventilation techniques have been criticised, and an arbitrary time limit of one hour recommended. It has also suggested that post-operative fever should be regarded as a contra-indication to the use of halothane, unless another obvious explanation for the fever exists.

On the other hand, interesting facts appear in the report. Of the 10 well-documented cases of anaphylactic/oid reactions, nine survived, and all but one are in their pre-existing state of health.

This study is wholly voluntary, both in notification and description of incidents. As such, of course, it is subject to considerable bias, but useful material does continue to be reported, and the Council’s publications appear promptly and at reasonable frequency.

In Melbourne in July, a symposium on anesthesia mishap was held. More complete reporting of this meeting will appear in a future issue, but a legal opinion given at the time has caused considerable concern. Briefly, it was to the effect that if a patient dies under anesthesia for any Mason, and a monitor which was available in the Operating Suite, has not been used, the anesthetist is indefensible in any subsequent action.

Clinicians expressed outrage at this simplistic approach, but were assured that however unscientific it may appear to them, courts, and particularly juries, see the matter differently.