Although adequate preoperative readiness of patients with pheochromocytoma decreases the myocardial oxygen imbalance with which the anesthesiologist must deal, these patients remain a challenge, requiring attention to detail. Thorough knowledge of the pathophysiology and applicable pharmacology will aid in the selection of the most appropriate drugs for the task. Preoperative evaluation, adequate monitoring, protection against stimulating maneuvers, and prompt response to hemodynamic changes remain the hallmarks of good anesthetic care for these interesting patients.