A thorough preoperative evaluation will provide both anesthesiologist and surgeon valuable information which may alter the course of patient care. Anesthetic preoperative evaluation is composed of four components: patient history, physical examination, laboratory studies, and anesthetic plan. A review of systems examination is usually a useful approach; this includes assessment of cardiac, pulmonary, renal, hepatic, neurological, gastrointestinal, endocrinological/metabolic, musculoskeletal, psychiatric, gynecological and obstetric organ systems. For ENT surgery, most of the time, anesthetic-related reasons for cancellation are due to recent upper respiratory infection or non-compliance with preoperative fasting guidelines. Evaluation of patient capacity sometimes enters into the process of informed consent or refusal in the elderly. Traditionally, anesthesiologists often consider perioperative cardiac and pulmonary events relatively controlled and easily reversible. While most of the ENT procedures are in the low surgical risk category, some of the large elective ENT operations are considered intermediate-risk surgery.