Artificial intelligence (AI) is reshaping the healthcare landscape, promising improvements in diagnostics, workflow efficiency, clinical decision-making, and much more. While its integration across various sectors accelerates, medicine lags due to justified caution and complex stakeholder needs. Anesthesiologists, as specialists rooted in data-driven technology, systems-level insight, hospital-wide collaboration, and strong clinical judgement, are uniquely suited amid uncertainty to lead the ethical and effective implementation of clinical AI. This chapter explores the key applications of AI in perioperative care, ranging from predictive analytics and real-time decision support to workflow optimization and administrative automation. It highlights how anesthesiologists can bridge the gap between algorithm simulations and clinical relevance. It also examines risks and challenges—such as patient safety, data quality, cybersecurity, implementation, liability, and costs—with a call for physician-driven innovation. As AI continues to evolve, the role of anesthesiologists as innovators, not just users, of responsible AI is paramount. Their leadership will help ensure that AI tools enhance patient care and clinical judgment in this transformative era of healthcare.