We want to thank Drs. Warner and Shi for the detailed letter in response to our editorial.1 

We were satisfied to see that we have similar opinions regarding many aspects of the smoking and smoking cessation. Furthermore, in our editorial we cited extensively Dr. Warner's studies in this field.

However, we are surprised that Drs. Warner and Shi interpreted our message as a warning against smoking cessation shortly before surgery. Our goal was to demonstrate that perioperative smoking cessation is a complex problem requiring more research to guide clinical practice.

We support Drs. Warner and Shi in their advocacy of smoking cessation at any stage of a patient's life, including the perioperative period. However, we could not ignore concerns regarding potential side effects associated with abrupt smoking cessation and their possible interference with the perioperative course. We used our editorial as an opportunity to highlight controversial areas in perioperative smoking cessation and call for more high-quality research to enhance our knowledge in this very important perioperative field.

Rita Katznelson, M.D., W. Scott Beattie, M.D., Ph.D., F.R.C.P.C.

**University of Toronto, University Health Network, Toronto, Ontario, Canada. scott.beattie@uhn.on.ca

Katznelson R, Beattie WS: Perioperative smoking risk. ANESTHESIOLOGY 2011; 114:734–6