Endotracheal intubation and tracheostomy may be an urgent, and essential procedure in cases of general anesthesia, airway obstruction, major head & neck surgery, etc, but it may cause many serious complications. The iuthors experienced a case of bilateral pneumothorax and generalized subcutaneous emphysema in a tracheostomized patient during general anesthesia with inhalation anesthetics. Herein the suthors present a case report and a review of the literature relating to the pneumothorax.