Because the letters by Drs. Abouleish and Cole touch on peer review and the mission of ANESTHESIOLOGY, I will also respond. Dr. Abouleish is familiar with the rigor of peer review at this journal, because he recently served on our Associate Editorial Board. Manuscripts are reviewed by content experts, often including one Editor or Associate Editor, and each review is rated for quality by the Handling Editor. Detailed instructions for reviewers are available on our Web-based system for peer review, and reviewers are asked to specifically rate the following five factors of quality and importance in the manuscript: clinical impact, scientific impact, interest to the specialty, novelty, and definitive interpretation. As Editor-in-Chief, I am responsible for all decisions, whether I handle the manuscript personally or review the recommended decision from the Handling Editor.

The mission of this journal is, “Promoting scientific discovery and knowledge in perioperative, critical care, and pain medicine to advance patient care.” Our goal is to provide the highest quality research, rated according to the criteria above, in order to better understand the foundations of our specialty and to affirm or revise practice. I believe that the correspondence concerning the original article1has helped clarify its contribution in this regard, and I thank all the authors of the manuscript and these letters for this discussion.


, Wake Forest University School of Medicine, Winston-Salem, North Carolina.

Epstein RH, Dexter F: Influence of supervision ratios by anesthesiologists on first-case starts and critical portions of anesthetics. ANESTHESIOLOGY 2012; 116:683–91