In well-resourced areas of the world anesthesia has become safer over the past decades, and anesthesia mortality does seem to be reducing. However, there is a lack of international agreement over definitions of anesthetic mortality and, therefore, difficulty in knowing exactly what the rate of anesthetic mortality is. Avoidable harm from error is still a problem, and sophisticated analysis suggests that more deaths than generally appreciated may be attributable to factors under the control of anesthetists. Mortality rates in low income areas of the world are unacceptably high. There is more to be done if anesthesia is to become truly safe for all patients.