ANÆSTHETIC DEATHS DUE TO REGURGITATION OR VOMITING

EIGHTEEN months ago the Association of Anasthetists set up a committee to investigate deaths associated with anzsthesia. As members of this committee we have studied details of forty-three cases where death resulted from regurgitation or vomiting. In many of the reports there was evidence of inexperience on the part of the anzesthetist, inasmuch as precautionary measures were either inadequate, or had not been taken even when clearly indicated. In due course the committee will issue reports on all notified anathetic deaths from every cause. Tn the meantime, we think that it might be opportune to offer a paper limited to the principal practical aspects of this particular problem. In our opinion most text-books of anasthetics fail to deal with this subject in a way likely to be helpful to the beginner. We have therefore ventured on a method of presentation which is frankly didactic, and have necessarily introduced several gross oversimplifications. We also realise that numerous pharmacological, physiological and pathological questions remain to be answered. These questions are implicit in many of the points we raise. We have made no mention of local or spinal techniques since we do not consider them satisfactory methods for the learner, and we are of the opinion that in anyone’s hands certain general anasthetic techniques are safe provided that adequate precautions are taken. We hope that this simple but systematic approach to the subject may commend itself to those who have had little acquaintance with the hazard of regurgitation or vomiting during anzsthesia. For trouble to occur there must be: (1) Material in the stomach or mophagus. (2) Something to cause the material to come out. (3) Facilities for the regurgitated or vomited material to come in contact with the air passages.