Surgical positioning is fundamental to safe and effective operative care. While positions are chosen to optimize surgical exposure, they also reshape cardiopulmonary physiology, alter perfusion and pressure at dependent tissues, and change the anesthetic risk profile. The most common surgical positions include supine, lateral decubitus, prone, steep Trendelenburg, and beach chair/sitting. All of those are associated with predictable patterns of hemodynamic change, ventilation–perfusion effects, and position-specific complications, including peripheral nerve injury, pressure-related soft tissue injury, vision loss, air embolism, airway edema, and upper-body venous congestion. Head pinning for craniotomy and cervical spine surgery adds further considerations (e.g., intense pain and sympathetic stimulation during pinning). Because airway rescue becomes more difficult once drapes are up and the patient is turned or fixed into place, anesthesiologists frequently elect general anesthesia with a secure airway in cases where intraprocedural airway access will be limited or delayed (e.g., prone, lateral, and beach chair with rigid head fixation). This chapter reviews positioning techniques, physiological implications, and perioperative risk. We discuss the practical rationale for why the airway management strategy is closely linked to the patient’s operative position. The goal is to provide internists with an integrated framework to anticipate position-related risks (e.g., vision loss in the prone position) and to understand the rationale behind specific anesthetic decisions.