Postoperative anesthetic complications are not uncommon. Nonetheless, surgical procedures induce specific anatomical and physiological changes. Managing patients undergoing surgery remains complex across various phases of hospital care. Anesthesiologists frequently administer up to half a million doses during their careers, and morbidity and mortality linked to improper dosing and administration postoperatively are frequent concerns. The likelihood of errors is unpredictable and can lead to serious consequences. This review aims to assist anesthesiologists in adopting updated clinical skills to better assess and manage anesthetic complications. The purpose of this literature review is to explore and discuss the main categories of adverse complications and mortality rates following anesthetic administration. The information was gathered through electronic searches, including Google Scholar and PubMed. Anesthesiologists need to classify complications systematically to outline anesthetic risks clearly. Doing so will improve outcomes for vulnerable patients and enable faster, more accurate interventions.
Managing surgical patients presents challenges across various aspects and stages of hospital care. A common question among anesthetists is, “How prepared are we to handle anesthesia-related complications?” There are several reasons why anesthetists must be equipped to address this question. While anesthetist trainees are expected to respond confidently and master strategies to prevent and manage these complex issues, providing a clear answer often proves difficult [1].
Some of the earliest recognized postoperative effects of anesthesia, typically managed in critical care settings, include airway and renal complications. Additionally, serious complications involving cardiovascular and cognitive dysfunction have been documented [2, 3]. Injuries related to the central and peripheral nervous systems have not always been a primary focus within anesthesiology; it is argued that neural function is often overlooked, especially during the perioperative period [2].
The effects of anesthetic medications require careful attention, as medication errors remain a significant concern after anesthetic administration. Morbidity and mortality caused by improper dosing and administration postoperatively are frequent challenges for anesthesiologists, who may administer up to half a million doses throughout their careers. The risk and unpredictability of such errors are both tragic and considerable [4].
This literature review aims to explore and discuss the major categories of undesirable complications and mortality rates following anesthetic administration. Furthermore, it seeks to help anesthesiologists develop new clinical skills to improve their assessment and management of anesthetic complications. Additionally, the review emphasizes the importance of maintaining a safe environment for managing patients undergoing anesthesia.
This overview research covers topics related to anesthesia complications and mortality spanning the years 1954 to 2018. The review was conducted through electronic searches using Google Scholar and PubMed. Only published studies written in English or translated into English were included for analysis. Relevant articles, clinical trials, documents, and review papers were selected for inclusion. The search strategy combined these MeSH keywords and terms: (“anesthesia” [MeSH], “mortality” [MeSH], “complications” [MeSH], “history” [MeSH], “incidence” [MeSH], “definition” [MeSH], “medication” [MeSH], AND “errors” [MeSH]).
For decades, anesthesia-related mortality has been a critical area of investigation. A study conducted from 1948 to 1952 across ten academic medical centers in the United States examined 599,500 surgical cases to evaluate deaths occurring around the time of anesthesia and surgery. The mortality rate was found to be as high as 64 deaths per 100,000 anesthetic procedures, influenced by factors such as the anesthetic agents used, patient health profiles, and types of healthcare providers. This translated to approximately 5,100 fatalities or 3.3 deaths per 100,000 population, surpassing deaths caused by poliomyelitis during that period [5, 6].
The 1954 report was pivotal in recognizing anesthesia safety as a significant concern in healthcare. This recognition led to improvements in anesthesia methods, training, drug administration, and safety protocols, driving the anesthesia-related mortality rate down from 1 death per 1,000 procedures in the late 1940s to 1 per 100,000 by the early 21st century [5, 7].
Postoperative pulmonary complications remain a serious challenge, especially in patients undergoing vascular and abdominal surgeries, where rates can reach 40% among those at risk [8, 9]. In contrast, among at-risk patients not receiving cardiac or obstetric surgery, complication rates stand at around 14.5%. Overall, about 2.8% of patients undergoing general anesthesia experience severe pulmonary complications [9, 10].
Acute renal injury following anesthesia carries a mortality rate that can reach 46%. This type of renal damage complicates up to 20% of hospital admissions and accounts for 30%–40% of perioperative acute kidney injuries acquired during surgery [11].
Several case reports and prospective studies have assessed the frequency of medication errors in anesthesia practice. These studies consistently show that medication error rates have remained between 0.33% and 0.73% over the past 15 years. A critical care safety study reported that medication errors resulted in harm to thousands of patients within medical and coronary care units, with cardiac stimulants, opioids, and vasopressors among the most commonly involved drugs [4].
The term “complications of anesthesia” broadly refers to adverse postoperative events, encompassing both common and severe conditions. Although postoperative anesthetic complications are not uncommon, surgical interventions provoke anatomical and physiological changes that influence the patient’s recovery and response. To better illustrate the risks associated with anesthesia, Table 1 categorizes these complications clearly and systematically [1].
Table 1. Systems, events, and outcomes categorize anesthetics’ risks and contributing factors [1]
Systems and related categories | Associated events | Undesired consequences | Complications contributing factors |
Lower airway tract | Tracheal intubation challenges | Injury to soft tissues, dental damage, and hypoxia | Insufficient expertise, airway complications, urgent situations |
Issues with incubation and oxygen delivery | Airway trauma, hypoxia, surgical complications, procedure delays, sudden death | Incorrect airway evaluation | |
Respiratory system | Excessive airway pressure | Pneumothorax, lung barotrauma | Inadequate muscle relaxation, obesity, pneumoperitoneum, and bronchospasm |
| endotracheal tube positioning | Hypoxia | Failure to auscultate the chest, limited experience |
Aspiration events | Pneumonitis, extended ventilation needs | Risk of reflux, non-fasted patient | |
Lung damage from needle insertion | Pneumothorax | Difficulties with central line placement, lack of skill | |
Cardiovascular | Low blood pressure | Cardiac arrest, ischemia, and neurological damage | Blood loss, Sepsis, hypovolemic shock, neuraxial block |
High blood pressure | Bleeding, stroke, rupture of an aneurysm, or anastomosis | Twilight sedation, poor pain control, and awareness | |
Central nervous system | Post-dural puncture | Headaches triggered by posture | Challenges in spinal or epidural procedures, insufficient expertise |
Epidural catheter misplacement | Pain during or post-surgery | Extended surgical duration, lack of skill, and procedural hurdles | |
Damage to the epidural vessels | Epidural hematoma causing paraplegia | Blood clotting disorders, anticoagulation, bleeding tendencies | |
Vaporizer activation failure | Psychological distress, awareness | Distractions, coexisting conditions, high-risk operations | |
Peripheral nervous system | Injections into nerves | Peripheral nerve injury, pain, and muscle weakness | Improper patient positioning, inadequate experience |
Drug-related | Allergic responses | Anaphylaxis | Patient-specific factors, incomplete medical history |
Negative drug reactions | Malignant hyperthermia | Patient-specific factors, inadequate history collection | |
Mistakes in drug delivery | Neuromuscular blockade, hypertension | Mislabeling, inattention, distractions | |
IV line infiltration | Loss of drug efficacy | Access difficulties Insert in situ lines from the ward |
Anesthesia-related mortality has been a prominent focus of investigation for decades. Emphasizing anesthesia safety as a significant health concern can play a vital role in advancing modern anesthesia techniques, drug development, and training approaches. Postoperative anesthetic complications are not uncommon, often arising from anatomical and physiological alterations following surgery. These changes can influence the patient’s recovery process and overall responsiveness. Anesthesiologists need to classify and document these complications clearly, thereby defining anesthetic hazards more systematically. Such categorization can lead to more effective and timely interventions, ultimately enhancing outcomes for high-risk patients.
None
None
None
None
Open Access The author(s) retain copyright. This article is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It may be shared and adapted for non-commercial purposes with appropriate attribution, an indication of changes, and distribution of adaptations under the same license. Third-party material may be subject to separate terms identified in its credit line. View the license at https://creativecommons.org/licenses/by-nc-sa/4.0/.
Publication System
