Background　Cholinesterase are widely expressed in human tissues and organs, especially in blood plasma and liver. Serum cholinesterase is used as an index of hepatic synthesis function. So far, serum cholinesterase has been found to play a critical role in the evaluation of patients' functional state of organism. Due to its participation in the drug metabolism, serum cholinesterase level can be used as an index for making drug selection by clinical doctors.　Objective　Here, we review studies on molecular structure, genetic background and physiological function of serum cholinesterase. This review provides reference for the perioperative evaluation and management of patients in clinical anesthesia.　Content　Different types of cholinesterase and their physiological functions are discussed. We focus on the change of serum cholinesterase and its value in the pre-anesthesia evaluation and drug selection.　Trend　With deeper studies on serum cholinesterase, its value in clinical care may be broaden.