What approach should an anesthetist take toward a patient who is facing surgery that might well be done with a regional anesthetic technique but who appears to have an airway that might be difficult to maintain?All anesthesiologists fear the day when we try to secure and maintain an airway in a patient quickly and find that technical difficulties prevent this. One of the reasons we see patients prior to surgery is to assess and evaluate the airway with particular attention to a potentially difficult intubation. Unfortunately there are times when a patient with an obvious anatomic problem might better receive a regional rather than a general anesthetic. Emergency limb surgery on patients with full stomachs, patients with severe rheumatoid disease, or the pregnant patient are appropriate examples. In these clinical circumstances we are often torn between proceeding with a regional or reverting to a general. I asked four experts in the field to address this question from two aspects—first in an emergent situation and second in an elective setting. Finally I asked them to discuss whether a perceived difficulty in performing an emergency tracheostomy might cause them to modify their management. William D.B. Pope, M.D.