Southern African Journal of Anaesthesia and Analgesia

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The long-term consequences of anaesthetic management

D I Sessler, M Cudahy


In distinct contrast to preventable anaesthetic mortality, which thankfully is now rare, all-cause postoperative mortality is surprisingly high. Approximately 5% of surgical patients die in the year following surgery. Mortality is roughly 10% in those who are older than 65 years of age.1 In other words, mortality in the year after surgery is approximately 10 000 times more common than preventable anaesthetic mortality. Thus, it is reasonable to ask to what extent anaesthetic management might influence long-term outcomes. The distinction being made here is between the classical definition of anaesthetic complications, which is restricted to the immediate perioperative period, perhaps extending to a few days after surgery, and the potential effects of anaesthetic management on events weeks, months or even years after surgery. Given that modern anaesthetic drugs are uniformly short acting, it is by no means obvious that the consequences of anaesthetic management could last more than hours or days after surgery. The long-term consequences of anaesthesia were not seriously considered until relatively recently. There is increasing evidence that some intraoperative anaesthetic management decisions have long-term consequences, and that others might as well.

Keywords: long-term consequences; anaesthetic management
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