Diaphragm dysfunction (DD) is a common perioperative disorder due to multiple causes. Unilateral DD dysfunction is more common than bilateral DD dysfunction, which can ultimately lead to respiratory failure. In recent years, more and more studies have paid attention to perioperative diaphragm protection. This review aims to summarize the anatomy and function of the diaphragm, clinical manifestations, and causes, as well as perioperative management strategies, especially emphasizing the importance of investigations concerning the mechanism and prevention and treatment of diaphragm dysfunction to improve anesthetic management and prognosis of these patients.