1 The provisional leading cause-of-death rankings for 2020 indicate that COVID-19 was the third leading cause of death in the US behind heart . Science does not support this claim., Lagasse compared anesthesia to the aviation industry: The safety of airline travel, for example, has increased dramatically in this century, but since the 1960s there has been minimal improvement in fatality rates. doc does not do endoscopy on patients in their 80s, with the exception of a bleed. From 2017 to 2019, the number of deaths declined to 14,139. Anesthesia enables a patient to tolerate surgical . . CHECK OUT BLOCHEALTH.COM, AVOIDING PREVENTABLE ERRORS IN ANESTHESIA 14 TIPS, 11 THINGS YOU CAN DO TO MAKE YOUR ANESTHETIC SAFER, 11 MEDICAL INACCURACIES IN FAMOUS MOVIE SCENES . Multivariate Cox Proportional Hazards modeling identified three variables as significant independent predictors of mortality: patient comorbidity (relative risk, 16.116; P <0.0001), cumulative deep hypnotic time (Bispectral Index <45) (relative risk=1.244/h; P=0.0121) and intraoperative systolic hypotension (relative risk=1.036/min; P=0.0125). . Anesthesia is very safe This is true nowadays, but wasn't always the case, Dr. Troianos says. What Type of Cardiologist Should You See for Specialized Heart Care? Complications of anesthesia during labor and delivery and systemic complications, such as malignant hyperthermia due to anesthesia, are not included. Anesthesiologists use a pulse oximeter to ensure that you get enough oxygen during surgery. In previous studies,6,18anesthesia-related deaths were usually divided into two groups based on clinical judgment: deaths caused primarily by anesthesia and deaths in which anesthesia played a partial role. I am having knee surgery to repair an all and remove meniscus portions. The International Statistical Classification of Diseases and Related Health Problems (ICD) is the standard classification system for recording and reporting diseases, injuries, and other health conditions.26Sponsored by the World Health Organization, this disease classification system is revised periodically and used by many countries for the compilation of mortality and morbidity data. Therefore the information on this website or on the linked websites should not be considered current, complete or exhaustive, nor should you rely on such information to recommend a course of treatment for you or any other individual. A death rate is a ratio between mortality and population. Allergic reaction to the anesthesia. You are healthy and young. This was followed by a slight increase in 2020, with 16,416 reported deaths. [1], featuring a hypothetical case scenario of a child death attributed to sedation, is not a true representation of the sedations performed many times daily in this country safely and according to guidelines jointly supported by the American Academies of . COVID-19 was the third-most-common cause of death in the U.S. in 2020, contributing to more than 375,000 deaths, and a 16% increase in the national death rate, according to provisional data . Doctors use a combination of IV sedation along with local or regionalanesthesiato make you more relaxed and comfortable, but not totally asleep. The most common minor complication was nausea and vomiting (nearly 36 percent) and the most common major complication was medication error (nearly 12 percent). WILL YOU HAVE A BREATHING TUBE DOWN YOUR THROAT DURING YOUR SURGERY? 56, 138lbs, atheletic and healthy. If propofol is used, an anesthesiologist or nurse anesthetist must be employed to safely administer the propofol. Fig. The estimated rates from anesthesia-related deaths were 1.1 per million population per year (1.45 for males and 0.77 for females) and 8.2 per million hospital surgical discharges (11.7 for men and 6.5 for women). Trust your anesthesiologist, and youll do great. Associated Anesthesiologists Medical Group. Lagasse wrote, We must dispel the myth that anesthesia-related mortality has improved by an order of magnitude. - The anesthesia consultant, ANESTHESIA EXPERT WITNESS - The anesthesia consultant, ON PEDIATRIC ANESTHESIA: THE METRONOME - The anesthesia consultant, WILL YOU HAVE A BREATHING TUBE DOWN YOUR THROAT DURING YOUR SURGERY? WILL YOU HAVE A BREATHING TUBE DURING YOUR SURGERY? Tests are done on the muscle to determine if you are MH susceptible. I am now 18, are there any tests that can be performed to determine if I am also allergic to succ? The objectives of this study are to develop a comprehensive set of anesthesia safety indicators based on the latest version of the International Classification of Diseases and to apply these indicators to a national data system for understanding the epidemiology of anesthesia-related mortality. While optimization of patient comorbidities is not always possible, having data regarding those comorbidities can prove life-saving. This allows doctors to adjust theanesthesiato maintain unconsciousness until the procedure is over, Dr. Troianos says. This virus has caused a high death rate of approximately 9,500 deaths as of December 2020. A QUESTION ABOUT REOPENING SURGERY. The risk of death from oral anesthesia is estimated at three deaths per every one million cases. email rjnov@yahoo.com. You may have seen movies that have used this as a plot point but its exceedingly rare, he says. Coming in 2019, from All Things That Matter Press: DOCTOR VITA, Rick Novaks second novel, FIVE MINUTES . . On the other hand, some of the deaths associated with anesthetics or analgesics identified through the ICD-10 codes may not be related to anesthesia practice. Equipment and medication considerations . ADVICE FOR LAYPEOPLE: HOW TO MAKE YOUR ANESTHETIC SAFER, ADVICE FOR PASSING ANESTHESIA ORAL BOARD EXAMS, ANESTHESIA EXPERT WITNESS CONSULTATION RICHARD NOVAK, MD, ANESTHESIA FACTS FOR NON-MEDICAL PEOPLE: ANESTHESIA MEDICATIONS. The toxicology report should show zero rocuronium in someone riding in a car. An anesthesiologist responds to common questions about safety, particularly general anesthesia. Im no expert on muscular dystrophies, but their diagnosis is usually also made via muscle biopsy under local anesthesia. Out-of-Network Surgery Centers and the Anesthesiologist, EMERGENCY AIRWAY BLEEDING AFTER SLEEP APNEA SURGERY, NEGATIVE PRESSURE PULMONARY EDEMA IN A FREESTANDING SURGERY CENTER, WHEN THE ER CALLS YOU ABOUT A RUPTURED AORTIC ANEURYSM, SMART PHONES AND PEDIATRIC ANESTHESIA INDUCTION, CHALLENGES FOR THE NEXT 25 YEARS OF ANESTHESIA, STOP-BANG AND OBSTRUCTIVE SLEEP APNEA IN A FREESTANDING SURGERY CENTER, HYPERTHERMIA IN A 7-YEAR-OLD PATIENT DURING EAR SURGERY. I am beyond shocked. There were an estimated 105.7 million surgical discharges from US hospitals during the study period. JAMA 1965; 194:11858, Greene NM, Banister WK, Cohen B, Keet JE, Mancinelli MJ, Welch ET, Welch HJ: Survey of deaths associated with anesthesia in Connecticut. (Harvard Health, 2019) New York leads the nation in medical malpractice payouts. I have had Iv sedation three other times with no issues, but they were for more minor oral surgeries. . ANESTHESIA FACTS FOR LAYPEOPLE: CHILDBIRTH, CARDIAC SURGERY, AND BRAIN SURGERY, FACTS FOR LAYPEOPLE: DRUGS ANESTHESIOLOGISTS ADMINISTER. DOES REPEATED GENERAL ANESTHESIA HARM THE BRAINS OF INFANTS AND YOUNG CHILDREN? Med Care 2005; 43:87384, Sedman A, Harris JM II, Schulz K, Schwalenstocker E, Remus D, Scanlon M, Bahl V: Relevance of the Agency for Healthcare Research and Quality Patient Safety Indicators for Childrens hospitals. The total mortality rate for horses presented for colic was therefore 33% (75/229). SHOULD YOU INJECT A CEPHALOSPORIN INTO A PATIENT WHO IS ALLERGIC TO PENICILLIN? It's due to the fact that more and more older patients are being operated on," says Dr. Andr Gottschalk, author of . An anesthesiologist weighs in on why you shouldn't be afraid. AN ANESTHESIOLOGISTS OPINION. Second, we estimated the risk of hospital anesthesia-related mortality based on the number of anesthesia-related deaths that occurred in hospitals as inpatients as recorded on the death certificate and national estimates of hospital surgical discharges. You will receive pain relievers IV to reduce the pain. Although mortality data are not subject to sampling error, they may be affected by random variation. AN ANESTHESIOLOGISTS VIEW, JANUARY 2014 LETHAL INJECTION WITH MIDAZOLAM AND HYDROMORPHONE AN ANESTHESIOLOGISTS OPINION, THE TOP 11 DISCOVERIES IN THE HISTORY OF ANESTHESIA, ANESTHESIA FACTS FOR NON-MEDICAL PEOPLE: ANESTHETIC TECHNIQUES, LETHAL INJECTION AND THE ANESTHESIOLOGIST. Anesthesia risks for healthy patients are very low. Anesthesiol Clin North America 2003; 21:41743, Institute of Medicine: To Err Is Human: Building a Safer Health Care System. DOES AN ANESTHESIOLOGIST NEED A STETHOSCOPE? Because mortality is considered "hard" data, it's possible to do time-trend analysis and compute percent changes over time. WHAT HAPPENED? The mortality data files are based on death certificates compiled by individual states and contain one record for each decedent. Deep down, every surgical patient has the same worry: How safe is anesthesia and surgery? Intravenous (IV) monitored sedation is also known as conscious sedation, twilight sedation or monitoredanesthesiacare (MAC). Please would like to hear your ideas. A sore throat because of the breathing tube (for generalanesthesia). In this report, the Committee on Quality of Health Care in America stated that, anesthesia is an area in which very impressive improvements in safety have been made. The Committee cited anesthesia mortality rates that decreased from 1 death per 5,000 anesthetics administered during the 1980s, to 1 death per 200,000-300,000 anesthetics administered in 1999. Detailed Description: There are risks to sedation for an upper GI endoscopy, but the risks are less than that of general anesthesia for a surgical procedure. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. The report by Beecher and Todd helped to identify anesthesia safety as a public health problem and spawned many follow-up studies in the United States710and other countries.1114This intense research effort has played an important role in the continuing improvement of anesthesia safety. FENTANYL AND THE OPIOID CRISIS: AN ANESTHESIOLOGISTS PERSPECTIVE. But its for this reason that a regional or local type of anesthetic is prescribed for elderly patients by their physician anesthesiologist. Cleveland Clinic is a non-profit academic medical center. A SPLENDID AND TIMELY NOVEL, THE FIRST CHAPTER OF DOCTOR VITA BY RICK NOVAK. My G.I. 3) Anesthesiologists may develop addictions to handle the stress of their job. You will almost certainly wake up! Med Health R I 2001; 84:3413, Lienhart A, Auroy Y, Pquignot F, Benhamou D, Warszawski J, Bovet M, Jougla E: Survey of anesthesia-related mortality in France. Finally, we based our estimates of death rates on population data and mortality risk on hospital surgical discharges. Labiaplasty 2.Had a mass removed behind my ear( just fatty tissue) 3. When mortality was defined as anydeath occurring within 48 hours following surgery, there were 351 deaths in 184,472 surgeriesan overall surgical mortality rate of 1 death per 532 cases. General anesthesia is actually very safe, and some desperately sick patients are in better condition under general anesthesia than when awake and breathing by themselves. HOW TO MAKE A BILLION DOLLARS IN HEALTHCARE, ROBOT SURGERY . That was 10 years ago, my tummy tuck was destroyed due to my last pregnancy plus the previous surgeon left me with a horrible looking scarred belly button and my scar is too high. Anesthesia-related Deaths by Type of Complication, United States, 19992005. This may be due to the effect that improved safety technology has had on air traffic density. And those who abusedrugs and alcoholare sometimes less affected byanesthesiathan othersdue to tolerance. In addition, it is possible that some deaths that occurred outside of hospitals may have been related to complications from inpatient anesthesia. WHY DOES ANYONE DECIDE THEY WANT TO BECOME AN ANESTHESIOLOGIST? HOW DOES A SURGERY CENTER INVESTIGATE IF A SURGEON IS PRACTICING BELOW THE STANDARD OF CARE? TABLE 2 Table 2. As part of our effort to close this research gap, we developed four anesthesia safety indicators based on the latest version of the ICD. THE DIFFERENCE BETWEEN A PHYSICIAN ANESTHESIOLOGIST AND A NURSE ANESTHETIST, THE TOP 20 DOCTORS IN THE HISTORY OF ANESTHESIA. After that problems accurred with my heart . Report of the Committee convened under the auspices of the Australian and New Zealand College of Anaesthetists. Advertising on our site helps support our mission. Many people have multiple safe anesthetics as they age. How Safe is Anesthesia in the 21st Century? Cleveland Clinic 1995-2023. With the rapid growth of clinical anesthesia services, considering methods for ongoing national surveillance for anesthesia exposure and outcomes is imperative. 1. The patients. We said: Our data uses the information supplied when a death is registered. Patient characteristics and comorbidities play a role in many of these events, highlighting the importance of preoperative screening. Hi! A VIEW FROM THE ANESTHESIOLOGY COCKPIT, ANESTHESIOLOGISTS, DONT BE AFRAID TO CUT INTO A PATIENTS NECK, EXTUBATION IS RISKY BUSINESS. ANAPHYLACTIC REACTION UNDER GENERAL ANESTHESIA, MANAGEMENT OF STROKE IMMEDIATELY FOLLOWING CAROTID ARTERY SURGERY. Monitoring has become less invasiveand clinical decision support systems are morecommon, ensuring patients better care than ever. A Spanish study 1 evaluated over 2,000 dogs that underwent anesthesia. When I was young, they did not want to test me because his reaction caused severe reactions like lockjaw and cardiac arrest. Your BMI is 33, which means you are obese. COVID-19 hasn't increased annual U.S. death rates. The results are being presented at the ANESTHESIOLOGY 2014 annual meeting. SHOULD YOU CANCEL SURGERY FOR A LOW POTASSIUM LEVEL OF 3.4 mEq/L? What are Death Rates? CATHETER ON A PATIENT WITH DIFFICULT VEINS. Background: Extracapsular femoral neck fractures (eFNF) are the third most common type of fracture in traumatology. 2). The first known case of the . Washington, D.C., The National Academies Press, 2003, pp 402, Albertsen PC, Walters S, Hanley JA: A comparison of cause of death determination in men previously diagnosed with prostate cancer who died in 1985 or 1995. You will have significant pain postoperatively, which is universal after this surgery. Brain damage as a result of having an anaesthetic is so rare that the risk has not been put into numbers. These codes were identified by screening all the chapters of ICD-10 and informed by a thorough review of the research literature pertaining to anesthesia mortality and ICD. Yet again, i need to put under a fourth time ;I have a molar and wisdom teeth under my gums causing me swelling and soreness. Each indicator refers to a group of complications or adverse events identified through specific International Classification of Diseases, 9th Revision, Clinical Modification codes.25The first indicator, purportedly measuring the safety of anesthesia, is limited to adverse effects of anesthetics in therapeutic use and overdose of anesthetics. Look at the chances of dying as a result of general anesthesia, pregnancy, and some relatively common planned operations. Thank you. WHAT WENT WRONG? The risk of death solely attributable to anesthesia is approximately 1 in 185,000 according to anesthesia textbooks. To facilitate the measurement of patient safety and the evaluation of intervention programs, the Agency for Healthcare Research and Quality developed more than 20 patient safety indicators for use with routinely collected hospital inpatient discharge data. Assuming you are not elderly, not sick, not obese, and that competent doctors are attending to you, your risks will be low. The hospital's annual obstetrics/gynecology discharges are classified as: delivered, 4,199; aborted, 57; not delivered (prepartum), 126; and postpartum, 66. AN ANESTHESIOLOGISTS ANALYSIS, DROPPING SUBSPECIALTY ANESTHESIA SKILLS . . The most popular posts for anesthesia professionals on The Anesthesia Consultant include: Should You Cancel Anesthesia for a Potassium Level of 3.6? Advice For Passing the Anesthesia Oral Board Exams. In 2021, the number of reported deaths involving prescription opioids totaled 16,706. . CAN WE PREVENT AGITATION IN PEDIATRIC PATIENTS FOLLOWING ANESTHESIA? Anaesthesia 1982; 37:856, Tikkanen J, Hovi-Viander M: Death associated with anaesthesia and surgery in Finland in 1986 compared to 1975. WHAT ONE QUESTION SHOULD YOU ASK TO DETERMINE IF A PATIENT IS ACUTELY ILL? Let me ease your worries. Anesthetic management and one-year mortality after noncardiac surgery. Hi I am having hernia surgery and have had passed episodes of svt nonsestanable , aswell as pvcs and pacs longer period of time. Colonoscopy( IBS-C) . Death associated with anaesthetic procedures is rare, 1-4 deaths per 10,000 anaesthesias. I went to see a new plastic surgeon and he advised me I would need another tummy tuck and lipo for the flanks plus if I liked I could increase the size of my breasts. JAMA 1961; 178:2616, Tiret L, Desmonts JM, Hatton F, Vourch G: Complications associated with anaesthesia: A prospective survey in France. . In the first half of the 20th century, deaths were mainly dominated by infectious diseases. This study aimed to identify and evaluate the perioperative risk factors that lead to blood transfusion in frail . What Are the Common Anesthesia Medications? For example, a 1997 . Adv Data 2007; 12:119, Kung HC, Hoyert DL, Xu JQ, Murphy SL: Deaths: Final Data for 2005 National Vital Statistics Reports, vol 56, No 10. Death rate in anesthesia is one of the most valuable methods to assess the safety of anesthesia practice among different types of patients. The Anesthesia Consultant does not recommend or endorse any specific tests, products, procedures, opinions or other information that may be provided on the linked websites. 9 In addition, cosmetic surgeries performed in a hospital, ambulatory surgery center, or office-based Their vital functions, such as blood pressure . The answer to your question depends on many things, such as the actual surgical procedure, your age, weight, and health history, and whether you are having an anesthesia professional attend to you or not. Nearly twice as many as the next highest specialty (surgeons). The majority (54.9%) of the decedents were aged 2554 yr. The rocuronium concentrations in a passenger would be an incidental finding unrelated to the accident or to his death. The estimated mortality risk from anesthesia complications for inpatients was 8.2 (867/105.7 [95% confidence interval, 7.49.0]) deaths per million hospital surgical discharges (11.7 [95% confidence interval, 10.313.1] for men and 6.2 [95% confidence interval 5.57.0] for women). LEARJET ANESTHESIA THE EARLY DAYS OF HEART TRANSPLANTATION. THE MOST IMPORTANT TECHNICAL SKILL FOR AN ANESTHESIOLOGIST? Anesthesiology, V 123, No 6, Dec 2015, 1312-1321) showed the following: Anesthesia is safer than it has ever been, but risk factors such as emergencies, very young or old patients, or sicker patients, do increase the risk. Could anesthesia be the cause of this . REMIMAZOLAM: NEW WONDER ANESTHETIC DRUG OR MEDICAL WHITE ELEPHANT? Table 1. International Classification of Diseases,10th Revision Codes for Anesthesia-related Conditions. My breast implants are now smaller since the water has been evaporating. I am about to donate a kidney. 2020 Anesthesia Conversion Factors (ZIP) - These are the anesthesia conversion factors used to compute allowable amounts for anesthesia services under CPT codes 00100 to 01999. The study protocol was reviewed and approved for exemption of informed consent by the Columbia University Institutional Review Board, New York, New York. Her gastroenterologist will not discuss the anesthesia risks. Indeed, older patients are the heart of the matter. There are risks of bleeding or breathing problems, but in competent hands you can expect to do well. We do see endoscopy sedation given to 85-year-olds for upper GI endoscopy. . A person undergoing general anesthesia is far from being nearly dead, or in a death-like state. The death rate varied with age (fig. Your mortality would be much lower than 5% over one year. Anesthesiologists have an important role in the anesthesia management in patients with COVID-19 utilization and require airway management. The Committee cited anesthesia mortality rates that decreased from 1 death per 5,000 anesthetics administered during the 1980s, to 1 death per 200,000-300,000 anesthetics administered in 1999. Reading the information on this website does not create a physician-patient relationship. I am 38 fairly healthy. . Mortality rate from COVID-19 in Ukraine as of May 2020, by region Liver cancer due to alcohol use death rate in Russia 1990-2019 Mortality rate in the EU in 2016 from various causes After your procedure, you may not remember what happenedbut thats not true in every case. The findings indicate there were 375,235 excess deaths, with 83% attributable to direct, and 17% attributable to indirect effects of COVID-19. The number of anesthesia-related deaths averaged 315 deaths per year, including 34 deaths caused primarily by anesthesia/anesthetics (fig. Other options such as am epidural, a spinal, or local anesthesia are less attractive. You are relatively young (51 years old), and yours is an elective surgery. CAN YOU LEAVE YOUR ANESTHETIZED PATIENT IN AN EMERGENCY? These drugs keep you from feeling pain during medical procedures. Arch Surg 2007; 142:2638, Koch M, Dayan S, Barinholtz D: Office-based anesthesia: An overview. Can Anaesth Soc J 1967; 14:197204, Clifton BS, Hotten WIT: Deaths associated with anaesthesia. The incidence of perioperative mortality that is directly attributable to anesthesia ranges from 1 in 6,795 to 1 in 200,200 anesthetics. PEDIATRIC ANESTHESIA: WHO IS ANESTHETIZING YOUR CHILD? Hello Doctor, For both sexes, the lowest rate was found in children aged 514 yr, and the highest rate was found in those aged 85 yr or older. Second, there is not an established national surveillance data system for monitoring anesthesia mortality. Ann Surg 1954; 140:234, Schapira M, Kepes ER, Hurwitt ES: An analysis of deaths in the operating room and within 24 hours of surgery. Death was the most important side effect of anaesthesia in dentistry. National estimates of hospital surgical discharges for the study period were generated from the National Hospital Discharge Survey using the defined surgical procedural codes28and were used as a proxy measure of exposure to anesthesia among hospital inpatients. Number of deaths per year since 2000 (including the full year 2000) under GA for dental procedures, either under the care of the Public Dental Service (PDS) or Oral and Maxillofacial Surgery (OMFS) The age of the patients that died. - The anesthesia consultant, DYING UNDER GENERAL ANESTHESIA - The anesthesia consultant, AN ANESTHESIA PATIENT QUESTION: WHY DID IT TAKE ME SO LONG TO WAKE UP AFTER ANESTHESIA?, THE NEW 2022 ASA DIFFICULT AIRWAY ALGORITHM. Using the estimate of the 2020 population from the Census Bureau, the death rate in 2020 was 10.4 deaths per 1,000, the highest death rate since 1943. See the reference below: Anesth Analg. HOW SAFE IS ANESTHESIA IN THE 21ST CENTURY? Age group and county, 1998-2020; Manner of death and county, 1998-2020; Medical Examiner cases, 2006-2020; COVID-19 information: Never disregard medical or professional advice, or delay seeking it, because of something you read on this site or a linked website. 1 However, there are side several known side effects. The infant will usually have a mask induction with sevoflurane, after which an IV is placed. THE NEW 2023 ASA GUIDELINES FOR QUANTITATIVE NEUROMUSCULAR MONITORING. Why Did Take Me So Long To Wake From General Anesthesia? 51 yrs old BMI 32 (But I am very muscular) Have had a history of SVT but keep myself pretty fit. WHAT IF YOUR SON NEEDS AN EMERGENCY APPENDECTOMY ON VACATION? In the past decade, the National Center for Health Statistics implemented a series of interventional programs (e.g. Approximately 11% of these deaths were caused primarily by anesthesia/anesthetics. It helps make sure the breathing tube used for generalanesthesiagoes into the trachea (windpipe) and not the esophagus something that was more difficult to determine in the past. its scary to think about, I just want to feel comfortable in my skin and feel pretty in a bikini. WILL YOU HAVE AN ANESTHESIOLOGIST FOR YOUR WISDOM TEETH EXTRACTION SURGERY? Anesthesia. . THE FUTURE: NURSE ANESTHETISTS OR M.D. MYOCARDIAL INJURY AFTER NONCARDIAC SURGERY . Estonia has the highest rate of 3-methylfentanyl overdose deaths in the EU, due to its high rate of recreational use. . Does this sound like a safe procedure for me? INTRAVENOUS ACETAMINOPHEN: AN IMPORTANT NON-OPIOID THERAPY, OR AN EXORBITANTLY PRICED VERSION OF AN OVER-THE-COUNTER MEDICATION? Is this a safe surgery for her? WHEN HEPATITIS C WAS TRANSMITTED FROM PATIENT TO PATIENT. . She had one episode of GERD/heartburn recently, and her doctor wants an endoscopy. The only time trace rocuronium would be present in the blood would be if the man had just been released from a surgery center after an uncomplicated anesthetic. SERIALIZATION OF THE DOCTOR AND MR. DYLAN CHAPTER THREE, SERIALIZATION OF THE DOCTOR AND MR. DYLAN CHAPTER TWO, SERIALIZATION OF THE DOCTOR AND MR. DYLAN CHAPTER ONE. NEW ANESTHESIOLOGY GRADUATES NEED TO KNOW _______. . Top 10 Countries with the Highest Death Rates (per 1,000 people) United Nations 2015-2020: Bulgaria 15.4 Ukraine 15.2 Latvia 14.6 Lesotho 14.3 Lithuania 13.6 Serbia 13.2 Croatia 13.1 Romania 13.0 Georgia 12.8 Russia 12.7 1.