Objective: The aim of this study was to anesthesia analyse the factors of conversing video-assisted thoracic surgery to thoracectomy in pulmonary carcinoma. Methods: Double-lumen tube bronchial catheter intubation and interstitial positive pressure ventilation (IPPV) were used in all patients with video-assisted thoracic surgery after fast-speed venous induced anesthesia. IPPV, positive expiratory pressure (PEEP) and continuous positive airway pressure (CPAP) in collapse lobes of lung were used in one lung ventilation, and ventilation parameters were adjusted. Results: Two hundred and fifity-two patients double-lumen bronchial tube intubation used by fiberscope was located very well. The level of oxygen saturation of blood (SpO2), end-tidal carbon dioxide pressure (PETCO2) could be maintained normal. 5 cases were forced to converse video-assisted thoracic surgery to thoracotomy because of 2 cases pulmonary adhesion, 2 cases severe pulmonary dysfunc-tion and 1 case abnormal anatomy respectively. Conclusion: Long one lung ventilation such as pulmonary adhesion, severe pulmonary dysfunction and abnormal anatomy should be considered to be relative contraindication.