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.


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