Nicotine replacement therapy (NRT) helps patients maintain prolonged abstinence; whether it might also be efficacious in helping smokers maintain preoperative "fasting" from smoking is not known. The goal of this study is to determine how to best decrease smokers' exposure to cigarette smoke immediately before surgery. The specific aim of this study is to test the hypothesis that NRT in the form of nicotine lozenges will decrease the exposure to cigarette smoke prior to surgery. This is a randomized, double blinded, placebo controlled clinical trial examining the efficacy of the nicotine lozenge in increasing preoperative abstinence from cigarettes in patients scheduled for elective surgery. Current smokers scheduled for elective surgery will be recruited in the Mayo Clinic Rochester Preoperative Evaluation Center and will receive a brief practice-based intervention encouraging preoperative abstinence for at least 12 hours before admission to the surgical facility. They will be randomized to receive either active or placebo lozenge. The primary outcome measure will be exhaled carbon monoxide (CO) concentration measured in the preoperative holding area. The secondary outcome measures will be the self-reported duration of preoperative abstinence from cigarettes, and the self-reported point prevalence abstinence rate measured one week postoperatively.