In Reply:—  I thank Dr. Roy for his thoughtful integration of the three editorials.1–3His broad overview of the evolution of anesthetic practice highlights two important points. As a result of the hard work of our forefathers, we have developed a remarkable understanding of “what anesthetics do.” These insights have produced unprecedented advances in patient safety, primarily as a result of improved monitoring and drug delivery systems. However, we are also reminded that we still don't understand “how anesthetics work.” This lack of knowledge has resulted in a paucity of radically new anesthetic drugs which, in turn, has contributed to a plateau in anesthesia-related mortality.4The specialty of anesthesiology must be ambitious and relentless in its efforts to develop safer anesthetic drugs and improved drug administration strategies. This effort will require a firm commitment to train young investigators who will bring the best science to bear on this important goal.

University of Toronto, Sunnybrook Health Science Centre, Toronto, Ontario, Canada. beverley.orser@utoronto.ca

References

References
1.
Orser BA, Saper CB: Multimodal anesthesia and systems neuroscience: The new frontier. Anesthesiology 2008; 109:948–50
2.
Hemmings HC Jr, Mantz J: Xenon and the pharmacology of fear. Anesthesiology 2008; 109:954–5
3.
Davidson AJ, McCann ME, Morton NS, Myles PS: Anesthesia and outcome after neonatal surgery: The role for randomized trials. Anesthesiology 2008; 109:941–4
4.
Lagasse RS: Anesthesia safety: Model or myth? A review of the published literature and analysis of current original data. Anesthesiology 2002; 97:1609–17