Millions of cigarette smokers undergo elective surgery each year. Efforts to help them quit smoking could improve immediate perioperative outcomes, such as those related to the cardiac and respiratory systems, and the healing of surgical wounds. Perhaps more importantly, the scheduling of elective surgery represents an excellent opportunity for smokers to permanently quit, with great benefit to their long-term health. Although it is difficult for smokers to quit, there are now several interventions of proven benefit that can more than double the chances of success. These include simple physician advice to quit, brief behavioral interventions that can be provided by physicians or other clinicians, and pharmacotherapy with drugs such as nicotine. Although specific strategies tailored for the surgical patient remain to be developed, there are steps that anesthesiologists can implement into their practices now that can help their patients quit smoking.