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The nature and origin of hypoxia is multifaceted. The prevention and treatment include optimisation of pre- and peroxygenation and the wise choice and use of neuromuscular blocking agents. Upper airway reflexes are important to anaesthetists as a clear airway allows safe ventilation of the lungs and oxygenation of the patient. Anaesthetic agents produce changes in the sensitivity of upper airway reflexes, with propofol being associated with depression of upper airway reflexes. This means that airway manipulation, and insertion of airways, including laryngeal mask airways, are more easily tolerated following induction of anaesthesia with propofol compared with other induction agents. Ageing leads to a gradual reduction in the sensitivity of upper airway reflexes. Cigarette smoking increases the sensitivity of upper airway reflexes, a change which persists for up to 2 weeks following cessation of smoking.