Anesthesia in low-to-middle income countries (LMICs) is often provided by nonphysician anesthetists. The training and resources for anesthesia in LMICs are limited, and this must be evaluated when starting or expanding a thoracic surgery program in LMICs. The ability to access a patient’s baseline pulmonary and cardiovascular status is often based on rudimentary studies and a thorough history and physical. Advance studies, such as echocardiograms, cardiovascular stress test, cardiac catherizations, pulmonary function tests, and MRIs, are often not available. Careful assessment of both preoperative patient selection, intraoperative ability to provide one-lung ventilation, and postoperative critical care management must be considered when surgical planning is occurring.