Adverse respiratory events are the most common type of injury in the American Society of Anesthesiologists (ASA) Closed Claims Study, accounting for 34% of 1,541 cases. These events resulted in death or brain damage in 85% of cases, with a median settlement or jury award of $200,000. Most outcomes (72%) were considered preventable with better monitoring. Three mechanisms accounted for three-fourths of the cases: inadequate ventilation (38%), esophageal intubation (18%), and difficult tracheal intubation (17%). Inadequate ventilation had the highest proportion of substandard care (90%). Esophageal intubation was associated with a recurring diagnostic failure, with 48% of cases leading to incorrect conclusions about tube placement. Difficult tracheal intubation had a lower proportion of preventable cases (36%). The study highlights the importance of monitoring with pulse oximetry and capnometry in preventing adverse outcomes. Esophageal intubation was often misdiagnosed through auscultation, with 48% of cases leading to incorrect conclusions. In most cases, the detection of esophageal intubation took 5 minutes or more. The study also found that difficult tracheal intubation had lower payment costs compared to other mechanisms, but the risk of adverse outcomes was still significant. The analysis suggests that better monitoring and improved investigative protocols could help reduce respiratory risks. The study emphasizes the need for education and research focused on respiratory risks in anesthesia. The findings highlight the importance of early detection and intervention in preventing serious adverse outcomes. The study also points out the limitations of current diagnostic methods and the need for more effective clinical algorithms to improve patient safety.Adverse respiratory events are the most common type of injury in the American Society of Anesthesiologists (ASA) Closed Claims Study, accounting for 34% of 1,541 cases. These events resulted in death or brain damage in 85% of cases, with a median settlement or jury award of $200,000. Most outcomes (72%) were considered preventable with better monitoring. Three mechanisms accounted for three-fourths of the cases: inadequate ventilation (38%), esophageal intubation (18%), and difficult tracheal intubation (17%). Inadequate ventilation had the highest proportion of substandard care (90%). Esophageal intubation was associated with a recurring diagnostic failure, with 48% of cases leading to incorrect conclusions about tube placement. Difficult tracheal intubation had a lower proportion of preventable cases (36%). The study highlights the importance of monitoring with pulse oximetry and capnometry in preventing adverse outcomes. Esophageal intubation was often misdiagnosed through auscultation, with 48% of cases leading to incorrect conclusions. In most cases, the detection of esophageal intubation took 5 minutes or more. The study also found that difficult tracheal intubation had lower payment costs compared to other mechanisms, but the risk of adverse outcomes was still significant. The analysis suggests that better monitoring and improved investigative protocols could help reduce respiratory risks. The study emphasizes the need for education and research focused on respiratory risks in anesthesia. The findings highlight the importance of early detection and intervention in preventing serious adverse outcomes. The study also points out the limitations of current diagnostic methods and the need for more effective clinical algorithms to improve patient safety.