Endobronchial ultrasound-guided transbronchial needle aspiration is the standard of care for evaluation of mediastinal and hilar lymphadenopathy. An ultrasonic bronchoscope is utilized to perform a transbronchial needle aspiration under ultrasound guidance. Both general anesthesia and sedation can be a safe anesthetic plan. Cough suppression during the time of aspiration is one of the principal goals to improve safety, and general anesthesia may better accomplish that goal. Airway management is typically performed with a laryngeal mask airway that best facilitates scope placement and allows access to higher lymph nodes. Paralysis is still sometimes utilized with the laryngeal mask airway. Complications can include pneumothorax, pneumomediastinum, and bleeding from mediastinal vessels. Thankfully the pneumothorax risk is small since the pleural space is not violated. The fact that a small gauge needle is utilized also prevents risk. Typically, patients will remain in the recovery room for 1–2 h in recovery, so anesthetic management should facilitate an expeditious discharge if possible.