In Reply:—

The recent editorial titled “Innocent Prattle”1congratulated Dr. Li et al.  for introducing new methodology to examine the epidemiologic patterns of anesthesia-related deaths at the national level. Specifically, they used International Classification of Diseases , 10th Revision (ICD-10) codes to identify anesthesia-related deaths from the multiple-cause-of-death data files maintained by the National Center for Health Statistics for the years 1999–2005. They then calculated death rates from anesthesia complications based on population data and hospital surgical discharge data. Using their innovative methodology, the authors found that the number of anesthesia-related deaths averaged 316 per year and the number of deaths with an anesthesia complication as the underlying cause averaged 34 per year,2for an estimated 30 million anesthetics annually. I also look forward to the application and validation by the scientific community of their techniques to monitor anesthesia safety in the future, but until such time, it is difficult to accept their claims that the United States has experienced a 97% decrease in the anesthesia-related death rate since the late 1940s and that 46.6% of anesthesia-related deaths are attributable to overdose of anesthetics and 42.5% are attributable to adverse effects of anesthetics in therapeutic use.2 

It is incredible claims of improved anesthesia safety that previously led to my analogy to The Emperor's New Clothes  by Hans Christian Andersen.3Some of our anesthesia community, like the townspeople in the fable, want to believe that we are somehow special, so they blindly accept these claims of improved anesthesia safety. In my analogy, I play the role of the child who is accused of “innocent prattle” by challenging the claims of Dr. Li et al.  in an editorial of the same name. I apologize to Dr. Li et al.  if my editorial led them to believe that their work was accused of being prattle. That was certainly not my intention. In fact, I see their role in my analogy as being much more noble.

Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.


Lagasse RS: Innocent prattle. Anesthesiology 2009; 110:698–9
Li G, Warner M, Lang BH, Lin H, Sun LS: Epidemiology of anesthesia-related mortality in the United States, 1999–2005. Anesthesiology 2009; 110:759–65
Lagasse R: Anesthesia safety: Model or myth? A review of the published literature and analysis of current original data. Anesthesiology 2002; 97:1609–17