Objective To discuss the anesthesia management in surgical treatment of uremia secondary hyperparathyroidism. Methods Twenty patients with uremia secondary hyperparathyroidism who were admitted from January 2018 to January 2020 were selected as study subjects, and treated by parathyroidectomy under general anesthesia. Their anesthesia management was analyzed retrospectively. Results During the surgery, 14 out of the 20 patients had low blood pressure, and 10 patients received continuous pumping of norepinephrine. The blood calcium and blood phosphorus levels after surgery were not significantly different from those 1 day before surgery. The calcium ion concentration 1 day after surgery was significantly lower than that 1 day before surgery. Among the 8 patients who developed hypocalcemia after surgery, 5 patients developed numbness in the lips and fingers 1 day after surgery, and then received timely calcium supplementation to address the symptoms. Hyperkalemia occurred in 2 patients during operation, and their serum potassium level were reduced to a normal range after glucose-insulin-potassium solution. The average waking time and extubation time of the 20 patients with uremia secondary hyperparathyroidism were （8.50±1.16） min and （9.24±1.59） min respectively. The distributions of the anesthesia effects among the 20 patients were level I for 10 cases, level Ⅱ for 8 cases, and level Ⅲ for 2 cases; the effective rate of anesthesia was 90.0%. Conclusion Patients with hyperparathyroidism secondary to uremia are very likely to have hypotension after induction of general anesthesia and during the operation. The patients’ blood pressure and electrolyte should be strictly monitored during the operation, and hypertensors should be applied as appropriate, thus ensuring the safety of surgical anesthesia.