Central airway obstruction (CAO) is defined as occlusion of more than 50% of the trachea or major bronchi, resulting from a range of malignant and nonmalignant etiologies. Accurate diagnosis relies on advanced imaging, particularly multidetector CT with 3D reconstruction, and functional assessment via pulmonary function tests and bronchoscopy. Management has evolved with interventional pulmonology techniques, requiring tailored anesthetic and ventilation strategies due to the high risk of airway compromise. Special considerations are necessary for dynamic airway conditions and mediastinal masses, with evidence guiding the use of positive-pressure ventilation and muscle relaxation in select cases. Ongoing research is needed to optimize perioperative care and outcomes for this complex patient population.