Now that open-heart surgery in children has become commonplace, one of the most spectacular operations in the pediatric population is the separation of conjoined twins. Anesthesia for the separation of conjoined twins requires a multidisciplinary team approach. We describe the anesthetic management of a single-stage separation of 2-month-old thoraco- xiphopagus tetrapus conjoined twins as a first case in Korea. The successful 3.25-hour operation was conducted by 6 anesthetists, 6 surgeons and 7 nurses. No any problems were encountered in the perioperative period.