The topic of clinical recommendations for management of patients with bradyarrhythmia in the perioperative period is relevant, since the development of life-threatening rhythm disturbances during general anesthesia can be accompanied by a critical disturbance of hemodynamics, leading to death or a deep neurologic deficit in patients. Recommendations are based on a deep and critical review of russian and foreign clinical guidelines and guidelines for managing patients with bradyarrhythmias in noncardiac surgery. The recommendations contain sections on the etiology and pathogenesis of perioperative arrhythmias; survey and monitoring methods; tactics of managing patients with certain types of bradyarrhythmias and sudden development of arrhythmia. The emphasis is on pathophysiological mechanisms of development, clinical signs and principles of treatment of potentially dangerous bradyarrhythmias: syndrome of sinus node weakness, critical conduction disturbance. Separately considered options for the development of intraoperative reflex bradycardia, which is a specific complication of some ophthalmic, maxillofacial and laparoscopic operations. In the form of a scheme, an algorithm of urgent medical measures for bradycardia is presented. The indications for the implantation of antiarrhythmic devices and the variants of anesthetic support for arrhythmological operations and procedures are set forth. The presented recommendations are based on the principles of evidence-based medicine, for each key recommendation, the levels of reliability and credibility of evidence are shown. The authors also developed the «Criteria for assessing the quality of care», which allow to assess the volume and quality of treatment activities in medical organizations that provide specialized anesthesia and resuscitation services and are equipped in accordance with Order No. 919 of the Ministry of Health of the Russian Federation of 15.11.2012.