In Reply:-We would like to thank Dr. Appleyard for his gracious comments regarding our report “Asystole and Severe Bradycardia during Epidural Anesthesia in Orthopedic Patients.” One of our main objectives in presenting this report was to make the anesthesia community aware of the severity and scope of bradyarrythmias that may occur during an epidural anesthetic. The importance of vigilance and “heightened awareness” of common complications on the part of the anesthesiologist intraoperatively is expected as a component of good clinical care. Dr. Appleyard's comments highlight the important role of the anesthesiologist as a perioperative physician. Health care workers who provide coverage for patients in PACU settings also should be aware of the type and severity of complications occurring after spinal and epidural anesthetics and be extensively trained in the most effective therapeutic interventions.

Gregory A. Liguori, M.D.

Nigel E. Sharrock, M.B., Ch.B.

Department of Anesthesiology; The Hospital for Special Surgery; 535 East 70th Street; New York, New York 10021