The multiple endocrine neoplasia (MEN) syndromes present a diverse array of challenges to the anesthesiologist. The tumors and their effects are often underdiagnosed and potentially discovered only when the patient is undergoing surgery for either a component of one of the syndromes or another procedure altogether. This can present the anesthesiologist with a life-threatening situation in the operating room. A thorough understanding of the syndromes, as well as management strategies, will enable the anesthesiologist to handle these patients. Advances in the pharmacologic armamentarium available to physicians have enabled patients with MEN, particularly those with the carcinoid syndrome or pheochromocytoma, to undergo surgery safely, with minimal morbidity and mortality. Awareness of the components of the MEN syndromes, as well as careful preoperative preparation, paves the way for a smooth anesthetic and postoperative course in these patients.