Anaesthesia for endoscopic ear, nose and throat surgery involves unique challenges. The anaesthetist and surgeon must work in close anatomical proximity, and the concept of the ‘shared airway’ is never more relevant. The anaesthetist requires a thorough understanding of the planned procedure and the specific requirements of the surgery in order to maximize accessibility to the surgical field whilst also providing safe airway management and maintenance of anaesthesia using a variety of specialist techniques. Planning for safe induction, maintenance and emergence from anaesthesia is guided by the underlying pathology and individual patient characteristics, and requires effective communication between the multidisciplinary team.