A retrospective study of anesthetic and surgical techniques involved in 55 consecutive cases of tracheal and carinal resections completed from 2001 to 2007, is presented. The anesthetic maneuvers and surgical approach differed in relation with the site of the tracheal lesions (upper, middle, lower trachea or carinal), the degree of the obstruction, the emergency of the surgical intervention and the concomitant presence of the eso-tracheal fistula. Ventilatory support during anesthesia involved special equipment adapted to the particular techniques used in this type of surgery. Cross field intubation of trachea or a mainstem bronchus, and High Frequency Jet Ventilation-HFJV- have been frequently used. Perfect coordination of the anesthetic techniques with every surgical step is mandatory and for good long term results special anesthetic equipment and a good preoperative anesthetic and surgical assessment of the strategy is needed.