Perioperative Risk Assessment and Decision Making

The administration of anaesthesia is an extremely safe procedure today. Data published by the American Society of Anesthesiology tell us that the risk of anaesthesia-related death has decreased 25-fold since 1970, from 1 in 10 000 to 1 in 250 000. In the USA, this risk reduction has closely followed a second trend, namely, a doubling of the number of working anaesthesiologists. All this has occurred during a time when the youngest of premature infants in neonatal units survives intricate, lifesaving procedures and 100-year-old patients undergo and recover from major surgeries that were once thought to be impossible. Today, safety in anaesthesia is comparable to safety in aviation, i.e. the risk of an aviation accident per departure is 0.96 in 1 000 000 for scheduled passenger operations (about 145 million departures during the last 10 years) and 2.64 in 1 000 000 for other operations (charter, cargo, demonstration, etc — about 25 million departures during the last ten years) [1]. Considering the greater number of deaths involved in a passenger aircraft crash, undergoing anaesthesia is actually safer than flying!