Indications for interventional pulmonary procedures continue to expand with modern technology and newer techniques in both anesthesiology and interventional pulmonology, a subspecialty of pulmonary medicine. Patients with significant comorbidities previously deemed “too sick” for traditional open thoracic surgical procedures are now able to undergo minimally invasive interventional pulmonary procedures with flexible or rigid bronchoscopes. With that, however, comes the added challenges of anesthetists to provide safe and effective anesthetic care to these sicker patients. Optimal anesthesia technique for interventional pulmonary procedures is often dictated by factors related to patients, procedures, and/or proceduralists. Various anesthesia techniques and special considerations for interventional pulmonary procedures where patient’s airway is shared with the proceduralist are described herein.