Providing perioperative care to infants and children undergoing thoracoscopic surgery presents a great challenge to the anesthesiologist. Minimal access surgery does not mean minimally invasive anesthesia. A thorough knowledge of the physiology of one lung ventilation, meticulous planning, continuous vigilance to detect any untoward event at the earliest and good communication between the anesthesiology and surgical teams all contribute to a safe and successful surgery. It is important to understand the physiology of lung ventilation and perfusion during surgery,monitoring requirements, appropriate anesthetic techniques, and methods of providing single lung ventialtion safely and effectively. Methods of postoperative analgesia are also important in managing pediatric patients undergoing thoracic surgery.