The thoracic trauma patient is generally of young, working age, and is often affected by multiple trauma. In its preoperative management, the functional repercussions secondary to thoracic injuries (pulmonary contusion, myocardial contusion, flail chest, etc.) should be evaluated. These become more important when anesthesia must be administered for surgical resolution of neurological, abdominal or limb injuries, and especially, when emergency thoracic surgery must be performed. Only 15% of patients with chest trauma require surgery. In emergency situations, regional techniques are limited to be a part of the postoperative analgesia or they are indicated in case of extensive nonsurgical parietal lesions. These are patients that have a full stomach in whom, in many cases, a chest drain must be installed prior to or during anesthetic induction. Induction agents that produce less hemodynamic compromise and maintenance with halogenated gases are suggested. Double-lumen endobronchial tubes are the standard method for providing lung isolation. Intraoperative mechanical ventilation should be provided considering the concepts of pulmonary protection taken from intensive medicine. Good postoperative analgesia facilitates respiratory physiotherapy, prevents deterioration of lung function, and allows early ambulation, helping altogether to reduce the incidence of pulmonary and thromboembolic complications.