Pain & Patience-Killer

Anesthesia has advanced far beyond the ether mask and morphine stage of 20 years ago. Today, during critical operations, e.g., inside the heart, as many as eight different painkillers may be administered to ease the patient's lot and the surgeon's task. Even in minor surgery, drugs are used lavishly to prevent discomfort. But even the best of the new techniques carry their own hazards. Last week two top Boston anesthesia experts, Henry K. Beecher and Donald Todd, laid down evidence that modern anesthesia is killing not only pain but is still killing a shockingly high percentage of patients.

Their findings, reported in the monthly Annals of Surgery:

P: Of 599,548 surgical patients studied in ten university hospitals over a five-year period (1948-52), 384 died of anesthesia, a ratio of one death to 1,560 patients. Nearly one-fourth of all surgical deaths attributed to causes other than patients' own ailments were from anesthesia.

P: The anesthesia mortality rate was higher among men than among women. Reason: men, the wage earners, tended to put off hospitalization until disease was advanced, were generally more susceptible to anesthesia's toxic effects because of heart and circulatory ailments.

P: Most dangerous of the drugs is curare, a muscle relaxant better known as the poison with which South American Indians tip their arrows. It accounts for one-third of the deaths caused by anesthesia: one death per 370 patients. When used in combination with ether, curare becomes more hazardous, causing one death per 250 patients. Administered during major surgery, the curare death rate soared to one death out of 192 patients.

Should curare and other risky medications (e.g., thiopental, cyclopropane) be banned from the hospitals? Beecher and Todd think not. But they urge that the drugs "available at present be considered on trial . . . employed only when there are clear advantages to be gained." The doctors regard anesthesia as a public-health problem. Applied to the entire U.S., the mortality rate uncovered by Beecher and Todd indicates that some 5,100 Americans die each year from anesthesia.

. . .

Dentists, as well as surgeons, have good cause to be wary of the use of anesthesia. Eighteen to 20 patients die in the U.S. each year from anesthesia in dentists' offices. Most common cause of death is brain damage from hypoxia (shortage of oxygen) caused by improper mixture of anesthetic gas, which should never contain less than 20% oxygen. The patient may survive a dose of gas that contains less than this minimum, but if it is prolonged or repeated, he may undergo personality changes or survive only as a moronic "vegetable." One dentist's proposed antidote: no dental anesthesia outside hospitals.

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