Preoperative consultation and preparation, and perioperative management of surgical patients are extremely important responsibilities of the internist. This issue of the Medical Clinics of North America provides new insights and recommendations on how to handle the following situations: emergency and urgent surgery; perioperative management of the ambulatory surgery patient; perioperative anticoagulation management; surgery in the patient with liver disease; surgery in the patient with renal dysfunction; hematological problems in the preoperative patient; obesity, the metabolic syndrome, and the surgical patient; identification and evaluation of the patient with lung disease; noncardiac surgery in the patient with heart disease; preoperative preparation in the patient for cardiac surgery; preoperative preparation of the surgical patient with neurological disease; and preoperative evaluation of the oncology patient.