Preeclampsia is a disease of unknown etiology and a major contributor to maternal and neonatal morbidity and mortality. With severe preeclampsia, numerous factors including intravascular volume depletion and susceptibility of developing pulmonary edema complicate anesthetic management. Invasive monitors such as CVP or PA pressure measurements are often required for guiding fluid management. When possible, lumbar epidural blockade is the preferred method for providing analgesia and anesthesia. Under all circumstances, a collegial and collaborative approach between obstetrician and anesthesiologist facilitates optimum patient care.