A vascular ring is a congenital malformation of the aorta and its branch vessels in which the esophagus and/or tracheobronchial tree are either completely (complete ring) or partially (incomplete ring) encircled by vascular structures and/or their atretic remnants, resulting in mechanical obstruction of these structures and resultant symptomatology. Vascular rings result from abnormal segmental regression and/or persistence of portions of the embryonic aortic arch complex. Infants may present with recurrent upper respiratory infections or pneumonia, wheezing, stridor, slow feeding, gastroesophageal reflux or vomiting, and/or failure to thrive. In children and older patients, the symptoms are similar to those seen in infancy with the addition of dysphagia to solids. Surgical division of a vascular ring is indicated when symptoms of airway and/or esophageal compression are present and is generally performed without delay once a diagnosis is made. This chapter highlights the perioperative anesthetic challenges in caring for a child for airway evaluation of a suspected vascular ring.