Telemedicine has evolved from a technological adjunct into a transformative tool in perioperative medicine, particularly within anesthesiology. This chapter examines the development, implementation, and future potential of telemedicine for preoperative airway evaluation, highlighting its clinical, operational, and economic impact. Drawing from decades of research—accelerated by the COVID-19 pandemic—it explores how both asynchronous (store-and-forward) and synchronous (live video) modalities enable accurate, safe, and efficient airway assessment. Telemedicine enhances perioperative workflows by reducing preadmission bottlenecks, expanding access for rural, elderly, and underserved populations, and improving patient and provider satisfaction. The integration of airway imaging into the electronic medical record (EMR) and the use of standardized protocols ensure consistency, safety, and data continuity. Beyond access and convenience, telemedicine demonstrates measurable cost savings, operational scalability, and alignment with value-based healthcare models. Ultimately, the chapter positions tele-anesthesia as a permanent and essential component of modern perioperative practice—extending the anesthesiologist’s role beyond the operating room into virtual domains of optimization, education, and systems-based leadership.