Airway difficulties after complex spine surgeries in prolonged prone position can cause catastrophic complications including severe hypoxia and death. This chapter presents a case study of a patient was a 22-year-old male with severe scoliosis scheduled for a T3-ilium fusion with vertebral column resections. This case discusses the importance of an appropriate extubation strategy in light of the known postoperative complications of prolonged prone positioning. Analgesia was administered using intravenous morphine, titrated to effect. Prone positioning during anesthesia is required to provide operative access for a wide variety of surgical procedures. The leak test and visual inspection of airway swelling are the most common risk assessment tests for extubation. Given the numerous complications unique to patients undergoing complex spine surgeries in the prone position, a systematic approach to extubation should begin as early as possible to optimize safe perioperative care.