Bronchoscopists are called upon to perform procedures on patients with mediastinal masses, in both urgent and elective settings for diagnostic or therapeutic purposes. Patients with a mediastinal mass represent a unique subset of those undergoing bronchoscopy because of the potential alterations in the structure of the tracheobronchial tree, lung parenchyma, heart, and great vessels caused by such lesions. Therefore, ensuring procedural safety requires the bronchoscopist to be aware of the potential complications that arise because of the mass, as well as those related to the administration of anesthesia. We present a literature review of anesthesia safety during adult bronchoscopy. A thorough evaluation and preparation for such complications should be a focus for the astute bronchoscopist. The planned approach should be individualized to the anatomy of the patient and the location of the mass. Most importantly, a management strategy should be in place for anesthetic-induced airway and hemodynamic catastrophes.