Anesthesia management in high-risk patients demands attention to preoperative evaluation, individualized anesthetic management, and ongoing intraoperative monitoring. Comorbid illnesses such as cardiovascular disease, respiratory failure, or metabolic disorders necessitate individualized approaches to reduction of perioperative risk. Care by anesthesiologists, surgeons, and critical care specialists is cooperative. Perioperative optimization and advanced monitoring increase safety, decrease complications, and maximize surgical outcome in these at-risk groups.