Dr. Barak is of course correct that surgery and anesthesia have advanced during the past two decades; for that matter, nursing care has also improved. However, as mentioned in my editorial,1now we also care for much sicker patients than in previous years.

The extent to which various factors contribute to improved perioperative outcomes remains unclear and will presumably never be accurately proportioned. Assigning credit (or blame) is less important than recognizing that our management decisions may influence long-term outcomes.

The Cleveland Clinic, Cleveland, Ohio. ds@or.org

Sessler DI: Long-term consequences of anesthetic management (editorial). Anesthesiology 2009; 111:1–4