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Poor management and techniques and improper drug doses contributed to 23 anaesthesia-related deaths in public hospitals between 2003 and 2005.

The Hospital Authority says 374,373 patients were anaesthetised in 20 hospitals over the three years. The 23 deaths related to the procedure occurred within 30 days of surgery.

The clinical audit on anaesthesia-related deaths, the first in Hong Kong, was prepared by the quality assurance subcommittee of the authority's co-ordinating committee on  anaesthesiology.

Subcommittee chairwoman Anne Kwan Siu-king said that in 10 of the cases,  it was  'reasonably' certain that anaesthesia was the sole factor leading to death.

In the remaining 13 cases there was either 'some doubt' or it was considered that both 'anaesthesia' and 'surgical' factors were the cause.

The incidence of anaesthesia-related deaths per 10,000 anaesthetics in Hong Kong was 0.61, higher than similar audits in Australia  and Japan.

Dr Kwan said  the disparity  might be due to differences in  the method used to calculate the figure.  Other countries might only look into deaths within 24 to 48 hours of surgery.

She pointed out that different factors, such as anaesthesia technique, drugs and management, were associated with each death, but it was not the subcommittee's aim to investigate mistakes.

'In some cases, the patients might not have known that they had coronary heart disease before the surgery, making it difficult for the anaesthesia doctors to assess the best anaesthesia method, such as the best drug dosage, for the patients,' Dr Kwan said.

'In  other cases, the situation might be so urgent that the medical staff could not keep good monitoring over the anaesthesia management.'

Most  anaesthesia-related deaths occurred in medically compromised and elderly patients, and many of these patients had undergone urgent or emergency major operations, she said.

Joseph Lui Cho-ze, the co-chairman of the co-ordinating committee, said the authority would draw up new practice guidelines to improve services.  Doctors could use the audit report as a basis to better explain the risk of surgery to patients.

He said it was  suggested that, whenever possible, anaesthesia should be provided by specialist anaesthesiologists or appropriately supervised trainees.  Not all public hospitals have a specialist anaesthesiologist on call on site around the clock.

Of the 23  deaths, seven were not attended by a specialist anaesthesiologist at the beginning of the operation. But Dr Lui said that if the situation during an operation deteriorated, a specialist would be called.



Hospitals audit links anaesthesia to 23 deaths of surgical patients