Perioperative smoking causes acute changes in cardiopulmonary function that can have unfavorable implications for patients undergoing anesthesia. These cardiopulmonary effects are carbon monoxide and nicotine mediated changes in oxygen (O2) delivery and myocardial O2 balance. Smokers also are at increased risk for postoperative pulmonary complications that are secondary to chronic changes in lung function. Smoking-induced acute changes in cardiopulmonary function can be largely avoided by a brief period of preoperative smoking abstinence. Bringing about a decrease in postoperative pulmonary complications requires a much longer period of preoperative abstinence. Because the perioperative period is in many ways an ideal time to abandon the smoking habit permanently, anesthesiologists, in cooperation with other health professionals, can perhaps play a more active role in facilitating this process.