The main purposes of anesthesia in neurosurgery are smooth induction, light levels of anesthesia and smooth emergence. This chapter is intended to provide an overview of anesthesia and its application to the neurosurgical patient in general and in specific circumstances. Preoperative evaluation should include a review of relevant history, medications and neurological and systemic problems. A clear understanding of the intracranial pathology, and problems associated with it during anesthesia and surgery is essential for proper planning and management. Both anesthetic techniques and agents greatly influence the ICP by their effect on intracranial blood volume. The overall effect on CBF depends on a balance between the concentration of the inhalational agent and the degree of hyperventilation. All inhalation agents are cerebral vasodilators; all intravenous agents except ketamine are cerebral vasoconstrictors. At induction sudden fluctuations in blood pressure should be avoided. Positioning of the patient is an important part of a neurosurgical procedure. Anesthesia is maintained with intermittent doses of narcotics and muscle relaxants. A well planned termination of anesthesia, avoiding fluctuations in blood pressure is rewarding.