BACKGROUND: Anesthesia for patients who have had to receive airway reconstruction surgery due to various causes may be the most challenging task in anesthesiology. A 3-year experience, in a consecutive series of 15 patients is herein reviewed. METHODS: We analyzed retrospectively the clinical status, the performed surgery, and the anesthetic management of the patients. RESULTS: The most common cause of airway obstruction was postintubation stenosis of the cervical trachea (6 patients). Tumor (3), trauma (2), tuberculosis (2), radiation (1), and the extrinsic compression (1) of the trachea or the main bronchus were the other causes. The kinds of surgery performed were resection and anastomosis (13 patients), external stent implantation (1), and lymph node excision (1). Airway control was successful during the perioperative period, and surgical death was never encountered. CONCLUSIONS: With careful preoperative evaluation of the status of the airway and close communication between the anesthesiologist and the surgeon, anesthesia during airway reconstruction surgery can be most worthwhile.