Anesthesia-related mortality The 1999 report of the Commission on Quality of Health Care under the U.S. Agency of Medicine noted that anesthesia safety has improved significantly in recent years, with confirmed anesthesia mortality declining from 2 in 10,000 in the 1980s to 1 in 200,000 to 300,000 by the end of the twentieth century, and that this data is not reflected as necessarily related to anesthesia for the following reasons: ① the cause of perioperative death is often It is very difficult to determine, and in many cases it is difficult to be sure whether it is necessarily related to anesthesia or intraoperative management; ② death in the real operating room is very rare, and patients in very poor or unstable condition are usually transferred to the ICU for further monitoring and treatment, and if such patients die in the CIU, people are less likely to attribute the cause of death to the anesthesia and intraoperative management for which the anesthesiologist is responsible; ③ very poor condition Patients or those who undergo complex major surgery, complications or death after surgery may be mostly due to their patients’ own physiological or pathological conditions, and less likely to be attributed to the intraoperative anesthesiologist’s ability to manage them. Therefore, it is difficult to accurately determine the impact of anesthesia on morbidity and mortality in surgical patients, but this does not detract from the factual assertion that anesthesia safety has improved significantly in recent years. Factors influencing surgical mortality Adverse cardiac events such as myocardial infarction, myocardial ischemia, congestive heart failure, and arrhythmias can lead to patient death during or early after anesthesia, and perioperative respiratory complications and a mild drop in body temperature can increase morbidity. The incidence of some unanticipated conditions directly caused by anesthesia such as hypoxemia, inadvertent tracheal tube into the esophagus or inability to perform tracheal intubation and mechanical ventilation are low, and the occurrence of these unanticipated conditions is due, at least in part, to technical malfunction of equipment or inadequate monitoring. fasting et al. analyzed 83,844 anesthesia cases over a 5-year period from 1996 to 2000 and found that the mortality rate was less than one in 200,000, and such a low mortality rate makes it difficult to analyze the factors influencing serious complications of anesthesia and prognosis and to propose appropriate prevention strategies. The occurrence of anesthesia complications such as death and serious complications is generally multifactorial and progressive, and the progressive aggravation of a single factor can also cause adverse events, which are usually serious but not fatal problems. To address the aforementioned analytical challenges, we have turned to the relatively common serious but nonfatal problems during anesthesia (identified by senior anesthesiologists) that may progress to adverse events, or may directly cause serious adverse events, or may not have any impact on patient prognosis at all, the “nearmisses”. These are the “nearmisses” that are the focus of preventive and curative strategies. In aviation, nuclear energy, and other high-risk industries, this “near misses” analysis has been shown to help analyze causes, suggest strategies, and reduce the incidence of accidents, so its application in the medical field, especially in low mortality areas such as anesthesia, is promising.