Major advances in surgical and anesthetic techniques have permitted critically ill patients to undergo surgical correction of complex congenital cardiac defects that were previously inoperable. Rodband and Wagner (1) performed the first experimental right ventricular bypass. Later, Glenn demonstrated that a right heart bypass could be successfully performed in humans by anastomosing the superior vena cava to the right pulmonary artery (2). This demonstrated for the first time that satisfactory pulmonary perfusion could be obtained with venous blood pressure. In 1971 the first successful case of total venous diversion was reported by Fontan and Baudet (3). The superior vena cava was anastomosed to the distal right pulmonary artery, and an aortic homograft was used to anastomose the right atrial appendage to the proximal right pulmonary artery. The Fontan procedure was initially developed for patients with tricuspid atresia. Because of the favorable outcome, indications for this procedure were expanded to include more complex cardiac lesions. Among these are transposition of the great vessels with a univentricular heart, pulmonary artery atresia or both. Although the surgical techniques for the Fontan procedure have been described in detail (3–8), there are no reports describing anesthetic management. Safe and effective management of these patients during the perioperative period requires appreciation of the pathological changes that occur before and after surgical repair. In this report, we review our anesthetic management of eight patients with various cardiac deformities who underwent the Fontan procedure.