Anesthesia management in elderly patients with pulmonary hypertension (PH) is complex and challenging for anesthesiologists. For a patient with PH to endure the perioperative period smoothly and without serious complications, such as cardiopulmonary problems, careful, comprehensive evaluation is crucial. We present the case of a 73-year-old male patient with severe PH being prepared for anterior lumbar interbody fusion and vertebroplasty. Anesthesia management was designed to maintain pulmonary vascular resistance and appropriate cardiac output and ensure the perfusion of vital organs. We conducted a preoperative evaluation with multidisciplinary consultations for this patient and used hemodynamic indicators such as central venous pressure (CVP), stroke volume variation (SVV), and cardiac output (CO), adequate sedation, analgesia, and anti-stress management during general anesthesia. The operation was successful, with no respiratory or cardiovascular complications.