Sir,Technological advancements have become part and parcel of the modern anesthesia practice. The intrusion of these technical trends has been overwhelmingly helpful and has changed the mindsets of anesthesiologists significantly, especially in the institutions and the bigger health centers. The introduction of newer technological advancements has helped in robust growth of anesthesia practice which almost parallels the pace of these technical innovations.Decision support system (DSS) is yet another addition to the pearls of advancing specialty of anesthesia, which almost functions in a similar manner to the human central nervous system.[1] It is basically a digitalized information receiver and relay center which in conjunction with anesthesia information management system (AIMS) helps the clinician in delivery of health services and simultaneously monitoring the well-being of the patient. Basically, it maintains the integrity and balance of inputs and outputs of all data and information which can be extremely helpful in daily routine operative and recovery room areas. However, the availability of computers and good networking among all the computers is an essential pre-requisite for successful installation and functioning of DSS in the hospital.The utility of DSS to anesthesiologist is highlighted by the fact that it can overcome the large gap of theory and practically based anesthesia services thereby limiting, if not eliminating, the errors and mishaps during anesthesia delivery services.[2] It smoothens and fastens the anesthesia services by integrating the various investigative laboratories, administrative, emergency and operation theater areas. Though AIMS has been making larger inroads into anesthesia practice, without DSS the utility of AIMS is limited in anesthesia.The practice of anesthesia is studded with rapid decision making and crucial junctures during perioperative period. The complexity of modern monitoring gadgets with the quantity and quality of parameters can induce errors during clinical decision making. This is where DSS exerts its importance as it allows a quick and appropriate action to administer the right therapeutic intervention, which can significantly impact the outcome in complicated clinical situations.The structural errors, deficits and incidents in operation theaters can be minimized by a good co-ordination and rapid information sharing by constituting a good teamwork, effective communication, standardization of protocols and procedures and periodic checking and maintenance of operation theater equipment.[3] Unless and until, the data and facts related to the incident are not gathered in entirety, it will be difficult to analyze the sequence of events correctly based on DSS. Only by adopting this methodology one can arrive at determining the real cause of the incident whether it is due to lack of human expertise (active failure) or due to a technical snag in equipment, non-availability of equipment or wrong procedural plans (latent failure).[4] DSS can help in arriving at suitable remedial measures after analyzing all these facts in entirety. One good example of this is alarm system is the pulse oximeter which can allow the detection of any adverse event by mere change of pattern of sound of pulse beep volume. Similar innovations have been incorporated into alarms of mechanical ventilators, anesthesia workstations and electronically controlled gas pipeline systems and so on.[5] During perioperative period, attempts have also been made to gauge the depth of anesthesia by observing the differences in the assessment of mean arterial pressure both by human beings and the computers.Incorporation of DSS in anesthesia has been progressive with an emphasis on improvement in easy understanding of the system and tools, user friendliness, intuitiveness and easy visibility of decisions.[6]Based on the evidence anesthesia practice new tools and techniques in DSS can be developed which can possibly help in assessing intra-operative blood loss, intravascular and volume status, assessment of depth of anesthesia and many others.[7] Further, DSS can help in designing and improving various clinical strategies such as patient controlled analgesia, post-operative nausea and vomiting (PONV), antibiotic prophylaxis before initiation of surgical procedures and many others. However, this can be possible only by prudent use of AIMS and DSS.[89]DSS has certain limitation which can hamper the appropriate utility of this tool. Delay in data feeding, omission of data, wrong data entry and latency in data management can significantly impact the decision making and management workflow thereby leading to non-desirable outcomes. Major limitation of DSS for anesthesia practice is that it cannot help in designing appropriate algorithms for administering anesthesia drugs during induction of anesthesia. Certain perioperative clinical situations can be handled by any of the alternative approaches but DSS limits its action to a particular approach only which is inherently fed into it.At present, the main use of DSS is in active smart monitoring and assessing depth of anesthesia, antibiotic administration, hemodynamic monitoring and PONV prophylaxis. In near future, we may see an improved evidence based DSS which can help in treating critical incidents during perioperative period.