Superior vena cava (SVC) lies in the upper mediastinum, laterally to the right in the great vessel area. It serves the venous drainage of the upper part of the body, including the brain, directing the flow to the right atrium. Lung cancer, mediastinal malignancies, benign conditions and a variety of other diseases and clinical conditions in the adult population may lead to surgery involving this large vein. This would be in the presence or not of superior vena caval syndrome, which includes classic features as dilated veins in the upper half of the body, edema of the head, neck and upper extremities, profound collaterals in the chest wall and cyanosis. Problems arising from the problematic SVC drainage, concerning the systemic and cerebral hemodynamics and the perioperative administration of drugs and fluids deserve focusing. The pre- and intraoperative evaluation and management of such patients and the decisions to be made are also for attention.