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
