This chapter deals with anesthesia for surgery to major intrathoracic structures excluding the heart and great vessels in neonates, infants and children. It focuses on thorough pre-operative assessment, intra-operative management including techniques for one-lung ventilation (OLV) and post-operative care including analgesia as well as a brief discussion of several conditions which present specifically in the pediatric patient population. Each phase of the anesthetic management of the pediatric thoracic patient should be carefully planned in advance and anesthetic nursing staff should be fully briefed. Two-lung ventilation is usually a perfectly acceptable and a simpler technique for many surgical procedures. To help reduce the chance of damaging the lung, apnea can be maintained while the thoracic cavity is entered. Providing satisfactory peri-operative management of the pediatric thoracic patient requires the highest standards of pre-operative assessment, technical expertise and communication between team members, but is both challenging and rewarding.