doi: 10.1097/ALN.0b013e318289e175

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Memtsoudis, Stavros G. M.D., Ph.D.; Liu, Spencer S. M.D.*

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We thank Dr. Myles for his thoughtful comments on our editorial1 and his contribution to the field of anesthesiology in general and comparative effectiveness research (CER) specifically. The points, including the disagreement with our categorization of the discussed trials, are well taken and are representative of a wider discussion about the question of what actually constitutes CER and what methodologies should be used to achieve it.2,3 Although the most commonly used definition in the United States today is that put forth by the Federal Coordinating Council for Comparative Effectiveness Research in 2009,* it can be argued that principles of CER have been followed in many other countries as early as the 1800s.2
In this context, we would like to state clearly that our intent was far from suggesting that the studies discussed and conducted by Dr. Myles and his colleagues do not conform to CER, because they clearly do individually and collectively, but rather to highlight an exciting evolution within anesthesia research that has been and continues to be under represented within CER. Although the intervention studied by Mashour et al.4 may not currently represent “common” practice, the use of anesthesia information management systems and related technologies is rapidly increasing throughout institutions worldwide with novel applications emerging at increasingly faster rates. Therefore, it is without a doubt that technology will influence the way we practice anesthesia today and in the future, demanding that these advances have to be tested against traditional practice before they become or can become common place. If the goal of CER is to maximize efficacy, effectiveness, and efficiency in our healthcare system, we should not be bound by traditional definitions when judging the value of the results of a study and perhaps even expand such criteria as to not risk them becoming obsolete.
Stavros G. Memtsoudis, M.D., Ph.D., Spencer S. Liu, M.D.*
*University of Washington, Seattle, Washington.
* FCCCER (Federal Coordinating Council for Comparative Effectiveness Research). “Report to the President and Congress.” Washington, DC: U.S. Department of Health and Human Services, June 2009. Available at: Accessed January 4, 2013. Cited Here...
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1. Memtsoudis SG, Liu SS. Bispectral index versus minimum alveolar concentration for prevention of intraoperative awareness: Does a practical controlled trial provide CERtainty? ANESTHESIOLOGY. 2012;117:693–5

2. Manchikanti L, Falco FJ, Boswell MV, Hirsch JA. Facts, fallacies, and politics of comparative effectiveness research: Part I. Basic considerations. Pain Physician. 2010;13:E23–54

3. Memtsoudis SG, Besculides MC. Perioperative comparative effectiveness research. Best Pract Res Clin Anaesthesiol. 2011;25:535–47

4. Mashour GA, Shanks A, Tremper KK, Kheterpal S, Turner CR, Ramachandran SK, Picton P, Schueller C, Morris M, Vandervest JC, Lin N, Avidan MS. Prevention of intraoperative awareness with explicit recall in an unselected surgical population: A randomized comparative effectiveness trial. ANESTHESIOLOGY. 2012;117:717–25

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