Objective — to develop a personalized premedication in neurosurgical patients considering data of neurosurgical diagnostic complex, psycho-emotional and autonomic status. Material and methods. A prospective, single-center, two-stage, controlled trial included 229 patients with diseases of central and peripheral nervous system who admitted for elective neurosurgical intervention. All patients were examined on the evening and on the morning prior to induction of anesthesia. Anxiety level was analyzed using the Integrative Anxiety Test (IAT). We also assessed Kerdo and Hildebrandt indices, Chermak-Goering and Danini-Ashner reflexes. Results. At the 1st stage, 108 patients were examined. It was found that parasympathicotonia was more common in older patients. Personal and situational anxiety did not depend on age (p>0.05). Patients without intracranial hypertension (ICH) had significantly higher personal (p=0.02) and situational (p <0.05) anxiety. At the 2nd stage, 121 patients with brain tumor were examined. Control group was characterized by increased situational anxiety (p<0.05) on the day of surgery in comparison with preoperative day in patients with low, moderate and high personal anxiety. Personal anxiety was not significantly changed in this case (p>0.05). In the main group, situational anxiety was significantly decreased on the day of surgery compared with preoperative day (p<0.05). We determined the main subtypes of combinations of psycho-emotional and vegetative status and suggested schemes of personalized premedication. Relationship of tumor location and state of autonomic nervous system was identified in patients with brain tumors. Conclusion. An algorithm for personalized premedication considering pharmacological effect on cerebral antinociceptive systems is proposed.