Ask Dr. Zhao: Can you die from too much anesthesia?

By Pei-shan Zhao

 

Yes, it is possible to die from too much anesthesia.

Doctors found 2,211 recorded anesthesia-related deaths between 1999 and 2005, based on death certificates maintained by the National Vital Statistics System at the National Center for Health Statistics. Of these, 46.6 percent were attributable to an overdose of anesthesia; 42.5 percent were attributable to adverse side effects of anesthesia during therapeutic use. The highest death rate was found in the 85 and older demographic. The study estimates that, on average, 8.2 out of 1 million hospital surgical discharges and 1.1 out of 1 million people in the general population die from anesthesia-related causes each year. In comparison, vehicular accidents in the United States cause about 11 deaths out of 100,000 people per year, a rate that is 100 times higher than anesthesia-related deaths in the general population. That is to say, the risk of dying from anesthesia is much lower than dying on the street.

A medical student practices administering anesthesia to a dummy. (Image courtesy of Vanier College.) 醫學院學生對假人練習施麻醉藥。(圖片來自Vanier College。)

A medical student practices administering anesthesia to a dummy. (Image courtesy of Vanier College.)

Most people think anesthesiologists administer anesthesia according to the patient’s body weight, which is true. We also look at the patient’s age, health condition, and sometimes the patient’s ethnicity. Although there is no study that proves a correlation between a patient’s ethnicity and the amount of anesthesia used, clinical experience suggests that many Asian patients are more sensitive to opioids and sedatives compared to American patients. Chinese patients also need less rocuronium — a drug which relaxes your muscles during surgery — to produce the same effect that occurs in Caucasian patients.

Generally speaking, patients will not be given too much anesthesia, since we watch what we give and how much we give carefully. We adjust the amount of anesthetics based on the patient’s condition. As bodily functions in multiple systems decrease with age, we decrease the dosage of anesthetics for elderly patients. The same situation applies to very sick patients, such as individuals with severe heart disease, lung disease, severe obesity and other health problems. These conditions put patients at higher risk for death under the stress of anesthesia and surgery.

A review of studies from different countries showed that anesthesia-related deaths in otherwise healthy patients occurred at a rate of 0.4 out of 100,000 people. However, the death rates increased to 27 to 55 individuals out of 100,000 in patients with uncontrolled medical problems, depending on the severity of the disease.

“Errors are an inevitable part of anesthetic practice. Anesthetists are humans and humans make errors,” wrote J.G. Hardman and I.K. Moppett in an editorial published in Deutsches Ärzteblatt International. Although this is true, the American Society of Anesthesiologists has been striving to improve patient safety. Actions taken include close supervision of anesthesiologist residents, limiting resident working hours, continuing medical education for well-trained anesthesiologists, simulator training for both resident and attending physicians, and much more.

Let me tell you a story. It is reported that anesthesiologists in the United States earn the highest salary in the medical field. While this is untrue, this rumor has spread to China, where doctors do not get the pay they deserve — not including “under the table” income. An American-trained anesthesiologist went back to China to give a lecture. He was asked whether he made a lot of money just by sitting in the operating room after injecting anesthetics into a patient. He replied, “I will give anesthesia for free if I can leave my patient after I inject anesthetics.”

What he meant was that anesthesiologists deserve their pay. Anesthesiologists not only inject anesthetics, but also monitor and manage patients continuously after the first injection. This is more critical for patient safety rather than the risk of overdosing the patient accidentally. Many people — including medical professionals — often do not understand what an anesthesiologist does.

Too much anesthesia does occur, but it does not necessarily cause patient death. Anesthesiologists are vigilant in monitoring patients for any problems and treating the patient immediately. If anything bad happens to a patient during surgery, the anesthesiologist is the first member of the medical team who will save your life.

 

Pei-Shan Zhao is an attending anesthesiologist and director of the Asian Community Outreach Program at Tufts Medical Center. He is a graduate of Peking University’s School of Medicine and has trained at Peking University and Caritas St. Elizabeth’s Medical Center.

This post is also available in: Chinese

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