We thank Dr. Georges Mion and Soledad Ricouard for their comments regarding our article1and their positive assessment of the work of the French Society of Anesthesia and Intensive Care and the Epidemiology Center on Medical Causes of Death at the National Institutes of Health and Medical Research. Their question regards fatigue as a factor facilitating human errors, and especially the role of sleep deprivation as a result of nighttime work. This question is indeed important enough that a government regulation was issued to mandate in France a period of “safety rest” after a night call.2This regulation did not exist at the time the study was performed and, as a matter of fact, in 9 cases of the 419 analyzed deaths (2%), the anesthesiologist having to perform an anesthetic after a night call has been noted as having possibly contributed to the fatal outcome. More broadly, circumstances having impaired the attention or the vigilance of the anesthesiologist, such as performance pressure, stress, or emergency, were found in 43% of cases. However, although the study methodology allows us to be confident regarding the number of deaths, even more so as analysis of files of insurance companies performed since then supports this point of view, the retrospective and belated nature of the analysis of factors facilitating medical errors implies a risk of underestimating these phenomena.

*Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France. a.lienhart@sat.aphp.fr

Lienhart A, Auroy Y, Pequignot F, Benhamou D, Warszawski J, Bovet M, Jougla E: Survey of anesthesia-related mortality in France. Anesthesiology 2006; 105:1087–97
Ministère de l’emploi et de la solidarité: Arrêté du 14 septembre 2001 relatif à l’organisation et à l’indemnisation des services de garde et à la mise en place du repos de sécurité dans les établissements publics de santé autres que les hôpitaux locaux. Journal Officiel de la République Française 2001; 217:14853