Ambulatory surgery numbers are rising in the United States at a rapid pace. Between 1996 and 2006, procedures carried out in free-standing surgical centers rose by 300 %. Airway management is a key factor in time management, patient safety, and cost-effectiveness. For the anesthesiologist practicing in a free-standing or office-based unit, patient selection and preparation for all eventualities are essential. A combination of traditional skills and advances in technology and anesthetic research are discussed to outline what we believe is a guide to safe anesthetic practice and airway management in the ambulatory setting. Pre-assessment of the patient, the management of the uncomplicated airway, and management of the anticipated and unanticipated difficult airway are discussed in this article.