Surgery of the upper airway requires diagnostic or therapeutic manipulation of the respiratory tree despite ongoing ventilation. Whether internal or external access to the conducting airway is required, the anesthesiologist and surgeon, who must work together closely, share the airway. The anesthetic technique is influenced by the chosen mode of ventilation. Recently, anesthetic agents with rapid onset short duration have become available, permitting a deep plane of general anesthesia with the prompt recovery resumption of spontaneous ventilation necessary to successful extubation of patients with compromised airway anatomy. Clinicians have responded to the challenge of ventilating the patient undergoing airway surgery with various innovative techniques. An outline of the resulting extensive literature is provided (Table 1 and Table 2).