During the last decade, major advances have been made in our understanding of the physiology and pharmacology of CNS muscarinic signaling. It is time to emphasize that the well-known peripheral parasympathetic and cardiovascular actions represent only one component of muscarinic signaling. Interestingly, many new findings have the potential to influence the practice of anesthesiology. Inhibition of muscarinic signaling may explain some of the anesthetic state, and subtype-selective drugs may allow wider perioperative manipulation of CNS muscarinic systems. The next years will doubtlessly see progress in this area, and our specialty may well reap the benefits.