'There, but for the grace of God...'

The number of deaths reported as associated with anaesthesia in England and Wales has fallen dramatically during the past 20 years. But the problem of cardiac arrest occurring while the patient is under the care of the anaesthetist, though small, remains a serious one because few such patients survive, even with serious complications, and the question of litigation may arise. A series of 66 cases reported to the Medical Defence Union during 1964-73 and studied personally has been analysed and the probable primary causes determined. It is concluded that cardiac arrest might have been prevented in about 50% of cases, though there was clear evidence of negligence in only 12. A study of the medicolegal aspects of anaesthesia emphasizes the wide area of the consultant anaesthetist's responsibilities, extending from preoperative assessment to postanaesthetic recovery. While some degree of delegation is unavoidable and perhaps desirable, the close personal relationship between patient and anaesthetist must be maintained.