key: cord-0944840-2varqfyj
authors: Hirata, Naoyuki; Yamakage, Michiaki
title: Reply to the letter
date: 2020-10-31
journal: J Anesth
DOI: 10.1007/s00540-020-02865-w
sha: 7a3e6d39a4be0ef6e7670341c82323488efbc624
doc_id: 944840
cord_uid: 2varqfyj

nan

We are grateful to Dr. Magoon for the helpful comments on our article [1] . As he pointed out in the letter to the editor, we have not referred to pulmonary-vascular consequences in the patients with COVID-19. Prolonged hypoxia and mechanical ventilation can cause pulmonary hypertension (PH) in patients with COVID-19. PH per se is a significant predictor of adverse cardiopulmonary outcome in surgical patients as reflected by increased postoperative complications in patients with co-existing high-risk clinical and surgical characteristics [2] . Anesthesiologists should provide appropriate anesthesia and analgesia with avoidance of exacerbating factors of PH (e.g., hypoxia, hypercapnia, acidosis, and hypothermia) and with administrating intravenous vasodilators (e.g., milrinone, nitroprusside, and nitroglycerine) [2] . While a specific strategy against PH in patients with COVID-19 has not been established, the use of nitric oxide may be a strategy in addition to the above conventional approaches [3] .

The letter from Dr. Magoon reminds us of the importance of pulmonary-vascular consequences during the COVID-19 pandemic.

Funding The authors have no financial interests in products related to this article.

Cardiovascular considerations for anesthesiologists during the COVID-19 pandemic

Perioperative risk and management in patients with pulmonary hypertension

Perspectives on cardiopulmonary critical care for patients with COVID-19: From members of the American heart association council on cardiopulmonary, critical care, perioperative and resuscitation

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