I often hear patients say, “I am not afraid of the surgery, just the anesthesia.

But should patients worry? Physician anesthesiologists suffered a crisis in confidence in

1982 when the ABC television program 20/20 aired, “The Deep Sleep: 6,000 Will Die or
Suffer Brain Damage,” about anesthesia complications, brain injury, and death. At that time,
physician anesthesiologists were having difficulty obtaining malpractice insurance because,
although anesthesia claims were not the most frequent, they were the most costly due to
outcomes associated with medical errors. Very often the error was an unrecognized
esophageal intubation, where the breathing tube was putting oxygen in the stomach instead of
the lungs. Estimates of mortality caused solely by anesthesia care ranged from 1 to 12 per
10,000.

At that time, ASA First Vice President Ellison C. “Jeep” Pierce, M.D., looked at the crisis
and had a choice: fight for tort reform so insurance payouts and malpractice insurance costs
would be decreased, making malpractice insurance more widely available, or increase the
safety of anesthesia . Dr. Pierce decided to establish a new ASA committee, the Committee
on Patient Safety and Risk Management, which was the first time “patient safety” was used in
this context. Additionally, ASA, under his leadership, formed the Anesthesia Patient Safety
Foundation (APSF) and started a Closed Claims project. Dr. Pierce was “on a perpetual
mission to prevent patients from being injured or killed by anesthesia care.” The APSF was
the first organization formed specifically to improve patient safety. Since that time, the
organization has funded and rewarded research and publishes a newsletter that continues to
incentivize advances in patient safety. The Closed Claims project collected malpractice cases
to discern causes of anesthesia accidents and prevent them.

Anesthesia advances in patient safety have included the pulse oximeter and end-tidal CO2
monitors, which make it very difficult to miss poor ventilation or an unrecognized esophageal
intubation. But that is not all. Multiple mistake-proof devices were developed. The
connections for the gas cylinders are pin indexed, so a mistake such as was featured in the
movie Coma, where the wrong gas is given, cannot occur. The anesthetic gas vaporizers are
color-coded, and the fillers are “keyed” so only the correct gas can go into the vaporizers,
which prohibits overdoses from accidentally occurring. The machine has a “fail safe” device
that makes it impossible to deliver less than 21 percent oxygen (the same as room air). In the
past, some machines had knobs that turned clockwise and others counterclockwise to increase
the oxygen delivery. Now they all turn in the same direction to increase or decrease gas flow.
All these changes easily increased patient safety.

This increase in patient safety was not created through the touch of a magic wand. It was
completed through the well-defined process that we call Plan Do Study Act (PDSA)
cycles. It was a man with a vision, an organization dedicated to saving lives, sharing ideas
and research, and insisting on excellence and persistence. Many small steps led to the
recognition of anesthesia as a leading specialty in patient safety in the 1999 landmark
publication To Err is Human. In fact, anesthesia is arguably the safest medical specialty
today. We are the closest to Six Sigma-level safety, which means that 99.99966 percent of the
time in a process, no defects are created. This method of measuring quality was developed in
the manufacturing sector, and it is the level of quality expected in the airline and nuclear
industries.

So for patients concerned about anesthesia, concern is understandable; but if patients follow
their preoperative instructions, ask questions, and choose their surgeon and surgical facility
carefully (Healthgrades, Consumer Reports and other data online) they will be well taken
care of. Rest easy about anesthesia. Patients are in the arms of the safest medical specialty
— physician anesthesiologists — the pioneers of quality and patient safety.
I often hear patients say, “I am not afraid of the surgery, just the anesthesia.”

But should patients worry? Multiple mistake-proof devices were developed. The
connections for the gas cylinders are pin indexed, so a mistake such as was featured in the
movie Coma, where the wrong gas is given, cannot occur. The anesthetic gas vaporizers are
color-coded, and the fillers are “keyed” so only the correct gas can go into the vaporizers,
which prohibits overdoses from accidentally occurring. The machine has a “fail safe” device
that makes it impossible to deliver less than 21 percent oxygen (the same as room air). In the
past, some machines had knobs that turned clockwise and others counterclockwise to increase
the oxygen delivery. Now they all turn in the same direction to increase or decrease gas flow.
All these changes easily increased patient safety.

This increase in patient safety was not created through the touch of a magic wand. It was
completed through the well-defined process that we call Plan Do Study Act (PDSA)
cycles. It was a man with a vision, an organization dedicated to saving lives, sharing ideas
and research, and insisting on excellence and persistence. Many small steps led to the
recognition of anesthesia as a leading specialty in patient safety in the 1999 landmark
publication To Err is Human. In fact, anesthesia is arguably the safest medical specialty
today. We are the closest to Six Sigma-level safety, which means that 99.99966 percent of the
time in a process, no defects are created. This method of measuring quality was developed in
the manufacturing sector, and it is the level of quality expected in the airline and nuclear
industries.

So for patients concerned about anesthesia, concern is understandable; but if patients follow
their preoperative instructions, ask questions, and choose their surgeon and surgical facility
carefully (Healthgrades, Consumer Reports and other data online) they will be well taken
care of. Rest easy about anesthesia. Patients are in the arms of the safest medical specialty
— physician anesthesiologists — the pioneers of quality and patient safety.