We report successful anesthetic management of an EXIT (ex-utero intrapartum treatment) procedure for fetal giant oronasopharyngeal tumor. A 34-year-old nul- liparous woman was diagnosed as having a fetus with giant oronasopharyngeal tumor and scheduled for an EXIT procedure at 34 weeks of pregnancy. After induction of general anesthesia and tracheal intubation, 6% desflurane and a moderate dose of remifentanil infusion were started to provide anesthesia for both the mother and the fetus. To achieve sufficient uterine relaxation during an EXIT procedure, desflurane was gradually increased up to 10% and nitroglycerin infu- sion was added just before uterine incision. Maternal blood pressure was maintained with continuous infu- sion of phenylephrine. Fetal monitoring during an EXIT procedure was performed with an electrocar- diogram using needle electrodes in addition to trans- thoracic echocardiography. No additional anesthetics were necessary for fetal immobilization. After the completion of tracheostomy followed by the separation of the fetus, nitroglycerin and desflurane were discon- tinued and adequate uterine tone was soon obtained. Maintenance of anesthesia was achieved with propofol and remifentanil for the remaining of the operation. The postoperative course was uneventful. The impor- tance of preoperative detailed simulation and discussion about the procedure among multidisciplinary team members was reconfirmed.