One of the anesthesiologist's greatest challenges is managing high-risk patients with acute or severe conditions.  This issue brings the anesthesiologist up to date on the most important and latest approaches to management of the sickest of patients.  Topics covered include managing the patient with sepsis or septic shock; anesthetic considerations for patients in respiratory failure; anesthetic concerns in patients presenting with renal failure; perioperative management of patients with liver failure; management of acute coronary syndrome in the OR; intraoperative concerns in patients presenting with sever aortic stenosis, aortic insufficiency, mitral regurgitation, or mitral stenosis; intraoperative management of patients with cardiac tamponade; anesthetic concerns in trauma victims requiring operative intervention; patients presenting with acute toxin indigestion; anesthetic concerns in patients with known neurologic insufficiency; management of endocrine insufficiency in the OR; and management of patients with mediastinal mass or tracheal stenosis.