Anesthesia for lung transplantation may be maintained using volatile agents or total intravenous anesthesia (TIVA). Volatile anesthetics may confer protection against ischemia-reperfusion injury, but should not be used as sole agents due to inconsistent uptake during ventilation interruptions and impaired perfusion. TIVA with propofol ensures consistent delivery and is preferred during ECMO. Opioids, typically hydromorphone or sufentanil, are used variably; sufentanil infusions offer hemodynamic stability with a favorable pharmacokinetic profile. Analgesia adjuncts like ketamine or lidocaine may benefit select patients. Thoracic epidurals improve outcomes but carry bleeding risks, while plane blocks are promising alternatives. Pre- and post-transplant opioid use impacts recovery and survival.