Pheochromocytoma and paragangliomas are neuroendocrine tumors that are associated with very rare secondary causes of hypertension. They are generally benign. While they can be medically managed, they ultimately require surgery to be cured. The focus should be directed toward stabilizing blood pressure before anesthesia and using medications with half-lives that endure anesthesia duration. Many adrenal tumors produce both norepinephrine and epinephrine or are predominantly epinephrine-secreting tumors, whereas most extra-adrenal tumors mainly produce norepinephrine. Thus, the presentation of pheochromocytoma depends on the catecholamines it makes. The two major issues surrounding pheochromocytomas that should be addressed before surgery include (a) hemodynamic control (namely control of hypertension and tachycardia) and (b) volume expansion to counter both the volume contraction that occurs with catecholamine excess and the potential hypotension that may occur intra- and post-operatively. Failure to address these issues before surgery can lead to lethal complications, including hypertensive crises, arrhythmias, and multi-organ failure. Some form of preoperative pharmacologic preparation is indicated for all patients with catecholamine-secreting neoplasms. Because of the limited number of large-scale randomized-controlled trials comparing different management strategies, there is no universally agreed upon preoperative approach. Combining individual alpha and beta-adrenergic blockade agents is one approach to preoperatively manage pheochromocytoma. It should be carried out sequentially, initiating alpha-adrenergic blockade first, and once a certain level of alpha blockade is reached, initiation of beta-adrenergic blockade should follow. Note, single-pill alpha-beta blockers such as labetalol and carvedilol are contraindicated as they are predominantly beta-blocking agents with a minor contribution to alpha receptor blockade. Details of this approach are discussed.