Approximately 20% of adults in the United States smoke cigarettes, and each year an estimated 10 million smokers undergo surgical procedures. Chronic and acute exposures to cigarette smoke cause profound changes in physiology that increase the perioperative risk of cardiovascular, pulmonary, and wound-related complications occurring (Figure 107-1). Thus, the knowledge of how smoking and abstinence from cigarettes affect perioperative physiology is of practical importance. This chapter will review (1) why smokers should maintain perioperative abstinence from smoking for as long as possible, (2) why surgery provides a good opportunity to quit smoking permanently, and (3) how anesthesiologists can help their patients quit smoking.