Improved surgical and medical management has led to an increase in survival after staged univentricular palliative procedures. Subsequently, this improved survival has led to an increase in the number of patients who will present for noncardiac surgical interventions with Fontan physiology. A comprehensive understanding of normal Fontan physiology and the perturbations that the proposed surgical procedure will likely have is necessary to care for and design a comprehensive anesthetic plan that takes into account the effects of anesthetic agents, ventilation strategies, cardiovascular drugs, and various other perioperative factors. Applying the knowledge presented in this article should enable the anesthesiologist with the necessary principles to care for the patient with Fontan physiology.