Smoking cigarettes has an impact on all aspects of the perioperative anesthetic. It is not known whether patients are typically educated regarding these effects. Eighty-one patients completed a questionnaire concerning smoking behavior in the 24 hours before surgery. Variables measured were smoking history, tobacco addiction, and preoperative education. Chi-square analysis was used. Of 81 participants, 66 (81%) smoked tobacco within 24 hours of surgery. Thirty-seven patients received no instructions to stop smoking, and only 2 patients abstained on their own. Of the 44 patients counseled not to smoke, 12 abstained from tobacco before operation. Thus, with counseling, the cessation rate was approximately 5 times greater (chi 2 = 7.0, P = .008). A second correlation was seen when the patients were informed about tobacco's risks related to anesthesia. The smoking rate decreased from 15% to 4%, a 4-fold decrease (chi 2 = 15.3, P = .0001). The results indicate patients who smoke are not routinely informed of the risks of tobacco use or the benefits of abstinence before surgery. Counseling has a positive impact on the patient's smoking behavior in the 24 hours preceding surgery. Anesthesia providers and surgeons have a renewed obligation to instruct patients not to smoke before surgery.