HIPEC is becoming an increasingly important adjunct in the therapy of peritoneal surface malignancies. Anesthetic management of these cases requires a thorough pre-op evaluation with an understanding of the significant fluid and electrolyte changes and the hyperdynamic state induced by thermal stress during the heated perfusion as well as optimizing co-morbidities to minimize the risk of morbidity and mortality during the perioperative period Taken together, the anesthesiologist has to deal with relevant fluid, blood and protein losses, increased intra-abdominal pressure, systemic hyperthermia and increased metabolic rate in patients undergoing cytoreductive surgery with HIPEC. It is of utmost importance to maintain or restore an adequate volume by aggressive substitution of intravenous fluids, which counteracts the increased fluid loss and venous capacitance during this procedure. Supplementary thoracic epidural analgesia can be recommended to guarantee adequate pain therapy and to reduce the rate and duration of postoperative ventilation as well as postoperative intravenous opioid administration.