A 76-year-old man who had previously undergone unilateral radical neck dissection (RND) was scheduled for contralateral radical neck dissection and reconstruction of the internal jugular vein (IJV) with the saphenous vein due to local recurrence of thyroid carcinoma infiltrating the IJV Reconstruction of the IJV was not necessary, however, because the preserved IJV was large enough to drain venous return after partial resection of the tumor-infiltrated part of the IJV. Reports of anesthetic management for bilateral RND are very rare. In this report, we discussed anesthetic management of bilateral RND including physiological changes and complications after bilateral IJV ligation and monitoring methods for disturbances of cerebral venous circulation.