Biphasic Cuirass Ventilation (BCV) is a modern negative pressure ventilation technique that uses a tight-fitting cuirass shell to induce negative intrathoracic pressure that enables respiration with or without airway intervention. BCV is an evolution of the iron lung, and it offers a physiological form of ventilation without sedation, paralysis, or endotracheal intubation. Its applications extend beyond critical care and are applicable in anaesthesia, particularly for upper airway procedures, offering an unfettered surgical field. BCV functions by way of an external plastic shell that creates negative pressure on inspiration and minimal positive pressure during expiration, closely reproducing natural breathing. The non-invasive method is particularly beneficial in patients with neuromuscular disease, difficult airways, or those requiring prolonged ventilation. In anaesthesia, BCV is being widely used in ENT and non-ENT surgery, including extremity, urological, gastrointestinal endoscopies, and non-operative intervention with sedation, where Total Intravenous Anaesthesia (TIVA) is optimal since the upper airway is maintained open. Other advantages include enhanced respiratory muscle strength, improved cardiac output, and reduced complications of invasive positive pressure ventilation. ASA standards dictate monitoring, and transcutaneous CO₂ measurement ensures adequate ventilation. BCV has been found to be beneficial in emergency medicine, resuscitation, radiotherapy, and critical care, including COVID-19 management, by ventilating efficiently without endotracheal intubation. Growing evidence in favour of BCV in difficult airway conditions, failed intubations, and risky interventions, since it is an adaptable and safe method. Being a tubeless technique of ventilation, BCV is a promising option in numerous clinical scenarios, with both physiological as well as practical advantages reaching beyond the field of anaesthesia.