Obesity and sleep apnea contribute to significant challenges in ambulatory surgical centers which include airway management and perioperative recovery. This narrative review was written following a literature review of articles available on ScienceDirect, PubMed, and Google Scholar from 2009 to 2024. This article highlights that obesity-related anatomical changes, such as increased neck circumference (NC) and reduced cervical extension, may complicate airway management. Successful ambulatory surgery for these high-risk patients depends on detailed attention throughout the perioperative period. Advanced airway techniques, along with continuous pulse oximetry and capnography, are vital for safe care. The use of continuous positive airway pressure or bilevel positive airway pressure in the perioperative phase is particularly beneficial in preventing respiratory complications. A systematic, multidisciplinary approach emphasizing preoperative screening, risk stratification, and standardized protocols is crucial for optimizing results.