Anaesthesia for thoracic surgery in children poses a variety of challenges for the paediatric anaesthetist, who will encounter problems different from those faced in adult practice. It is a low-volume surgical speciality, thus predominantly confined to specialist paediatric centres with anaesthesia required for a heterogenous range of conditions. One-lung ventilation may often be required, and knowledge of the techniques used for the varying size of the paediatric airway is essential. The impact of patient positioning, surgical retraction of the lung and the underlying disease process poses further challenges to the paediatric anaesthetist. This chapter covers management of the most common paediatric specific disease processes, including congenital and acquired lung abnormalities, intrathoracic masses, intrapleural collections and pectus surgery with an emphasis on lung isolation techniques and perioperative analgesia, including regional anaesthesia.