Introduction : Smoking is an important factor that affects human health, particularly the respiratory and cardiovascular systems. Therefore, smoking can influence a patient’s response to anesthesia and may increase the risk of certain complications during and after surgery. Cigarette smoke contains many substances, including nicotine, carbon monoxide, and oxidative chemicals, which can affect oxygen transport, lung function, and cardiovascular function. Effect of Smoking on the Respiratory System : Smoking causes airway irritation and increases mucus production. It also impairs the function of the cilia, which help clear secretions from the respiratory tract. During general anesthesia, smokers may be more likely to experience respiratory problems such as increased airway secretions, coughing during or after anesthesia, bronchospasm, reduced oxygenation, and difficulty maintaining adequate ventilation. Effect of Smoking on the Cardiovascular System : Nicotine in cigarette smoke can stimulate the sympathetic nervous system, which may increase heart rate and blood pressure and cause vasoconstriction. Carbon monoxide also binds strongly to hemoglobin, reducing the ability of the blood to carry oxygen. This may be particularly important during anesthesia and surgery. Effect of Smoking on Anesthesia :The patient’s smoking history should be considered during the preoperative assessment. The duration of smoking, the number of cigarettes smoked per day, the time of the last cigarette, and any associated respiratory or cardiovascular diseases are important factors when developing an anesthesia plan. Smokers may require careful monitoring of oxygenation, ventilation, and cardiovascular function during surgery and during recovery from anesthesia. Smoking and Postoperative Complications : Smoking may be associated with an increased risk of certain postoperative complications, particularly respiratory complications. These may include coughing, increased airway secretions, reduced oxygenation, and breathing difficulties. Smoking may also affect wound healing because of its effects on tissue oxygenation, blood flow, and normal tissue function. Role of the Anesthesiologist : The anesthesiologist plays an important role in reducing anesthesia-related risks by assessing the patient’s smoking history, evaluating respiratory and cardiovascular function, assessing oxygenation when necessary, and selecting an appropriate anesthesia technique. The anesthesiologist also provides continuous monitoring during surgery, monitors the patient during recovery, and provides appropriate advice regarding smoking cessation. Conclusion : Smoking affects the respiratory and cardiovascular systems and may increase the risk of certain complications associated with anesthesia and surgery. Therefore, obtaining a detailed smoking history, performing an appropriate preoperative assessment, and carefully monitoring the patient during and after anesthesia are important aspects of safe anesthetic practice. Assistant Lecturer Qasim Abbas. Al Mustaqbal University The First University in Iraq