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Children
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Anesthesia and Perioperative Management in Pediatrics
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Anesthesia and Perioperative Management in Pediatrics

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Anesthesiology, Pain Medicine and Palliative Care".

Deadline for manuscript submissions: 25 July 2026 | Viewed by 1654

Special Issue Editors

Dr. Senthilkumar Sadhasivam

E-Mail Website
Guest Editor
UPMC Children’s Hospital of Pittsburgh, Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, 4401 Penn Avenue, Pittsburgh, PA 15224, USA
Interests: pediatric and adult anesthesia; pain management; fetal anesthesia; regional anesthesia
Special Issues, Collections and Topics in MDPI journals
Dr. Barbora Nedomová

E-Mail Website
Guest Editor Assistant
Department of Pediatric Anesthesiology and Intensive Medicine, Faculty of Medicine, Come-nius University and National Institute of Children’s Diseases, 833 40 Bratislava, Slovakia
Interests: pediatric anesthesia; airway management; vascular access; perioperative pain management

Special Issue Information

Dear Colleagues,

Pediatric anesthesia and perioperative management have evolved substantially over recent decades, supported by advances in surgical techniques, anesthetic agents, monitoring technologies, and perioperative care models. These developments have contributed to improved safety and outcomes in children undergoing surgical and diagnostic procedures. Nevertheless, pediatric patients continue to present unique physiological and developmental characteristics that require careful planning and an individualized perioperative approach.

The aim of this Special Issue is to provide a comprehensive overview of current concepts and emerging strategies in anesthesia and perioperative management in pediatric patients. The scope includes preoperative assessment and risk stratification, airway management, perioperative pain management, vascular access, perioperative monitoring, and postoperative care, with a focus on safe, effective, and individualized clinical practice.

This Special Issue highlights cutting-edge research addressing innovative anesthetic techniques, perioperative pathways, and interdisciplinary approaches that support individualized decision-making and optimize clinical outcomes in pediatric populations.

We invite original research articles, systematic and narrative reviews, clinical guidelines, and high-quality case series that contribute to advancing evidence-based perioperative care in children.

Dr. Senthilkumar Sadhasivam
Guest Editor

Dr. Barbora Nedomová
Guest Editor Assistant

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pediatric anesthesia
  • perioperative care
  • airway management
  • perioperative pain management
  • patient safety
  • postoperative care

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (3 papers)

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Research

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13 pages, 535 KB  
Article
Intraoperative Low-Dose Methadone for Pediatric Posterior Spinal Fusion: A Single-Center Retrospective Cohort Study
by Roshni Cheema, Kristina Boyd, Mihaela Visoiu, Hsing-Hua Sylvia Lin, Scott E. Licata, Ruth Ressler, Vishali Veeramreddy, Shraddha Sriram, Selena Rashid, Senthilkumar Sadhasivam and Paul Hoffmann
Children 2026, 13(3), 400; https://doi.org/10.3390/children13030400 - 13 Mar 2026
Viewed by 526
Abstract
Background: Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis causes significant postoperative pain and high opioid requirements. Methadone, with dual μ- and κ-opioid agonism and NMDA antagonism, provides long-acting analgesia and may reduce perioperative opioid use. This study evaluated whether perioperative low-dose methadone [...] Read more.
Background: Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis causes significant postoperative pain and high opioid requirements. Methadone, with dual μ- and κ-opioid agonism and NMDA antagonism, provides long-acting analgesia and may reduce perioperative opioid use. This study evaluated whether perioperative low-dose methadone (0.1 mg/kg) improves postoperative pain and opioid outcomes after pediatric PSF. Methods: In this single-center retrospective cohort study (January 2019–June 2023), pediatric patients <23 years old undergoing PSF were categorized by perioperative methadone exposure (intraoperative and/or postoperative) versus no methadone. The primary outcome was total postoperative opioid consumption (morphine milligram equivalents per kilogram, MME/kg) over postoperative days (POD) 0–3. Secondary outcomes were average daily pain scores and hospital length of stay (LOS). Inverse probability weighting (IPW) adjusted for age, sex, and protocol period. Results: A total of 339 patients (51% no methadone, 49% methadone; mean age 14.6 ± 2.5 years; 76% female) were analyzed. Methadone patients had longer anesthesia (392 vs. 372 min, p = 0.042) and surgery times (287 vs. 266 min, p = 0.01). IPW-adjusted associations show postoperative opioid use was significantly higher in the methadone group on POD 0 (median 2.5 vs. 2.1 MME/kg in no methadone group; p = 0.005). No significant differences were found in postoperative average pain scores (e.g., mean NRS: 2.3 vs. 2.5 on POD 0, p = 0.12) and LOS (3.3 vs. 3.1 days, p = 0.38) between methadone group and no methadone group. Discussion: Perioperative methadone provided similar analgesia for pain management and recovery without prolonging hospitalization, despite higher early opioid use on POD 0. Retrospective design limits causal inference, and residual confounding may persist despite propensity score-based adjustments. Further prospective trials are required to establish safety and dosing. Conclusions: In this retrospective cohort, perioperative low-dose methadone was associated with higher early postoperative opioid use but no significant differences in pain scores or length of stay compared with standard regimens. Methadone did not demonstrate an opioid-sparing effect in this real-world setting. Prospective studies are needed to better define its role and safety in pediatric posterior spinal fusion. Full article
(This article belongs to the Special Issue Anesthesia and Perioperative Management in Pediatrics)
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Review

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13 pages, 286 KB  
Review
Multidisciplinary Strategies for Tailored Anesthesia Management in Children Undergoing Radiotherapy
by Salvatore Palmese, Renato Gammaldi, Alessandro Vittori and Marco Cascella
Children 2026, 13(5), 587; https://doi.org/10.3390/children13050587 (registering DOI) - 23 Apr 2026
Viewed by 116
Abstract
Although radiotherapy is a cornerstone in the management of several pediatric malignancies, its administration in children poses unique anesthetic challenges. Unlike adults, pediatric patients, particularly younger children, often require repeated sedation or general anesthesia to ensure immobility and reduce psychological distress during daily [...] Read more.
Although radiotherapy is a cornerstone in the management of several pediatric malignancies, its administration in children poses unique anesthetic challenges. Unlike adults, pediatric patients, particularly younger children, often require repeated sedation or general anesthesia to ensure immobility and reduce psychological distress during daily treatment sessions that may extend over several weeks. This narrative review summarizes current evidence on anesthetic strategies for children undergoing radiotherapy, focusing on clinical indications, pharmacological approaches, safety considerations, and organizational aspects. We discuss the main sedation and anesthesia techniques used in non-operating room anesthesia (NORA) settings, including deep sedation with midazolam, propofol, ketamine, and dexmedetomidine, as well as general anesthesia with laryngeal mask airway management. Particular attention is given to the cumulative effects of repeated anesthetic exposure, airway management challenges in remote radiation environments, and the risk of respiratory and hemodynamic complications. The review also highlights the importance of individualized, protocol-driven management, rapid recovery strategies, and continuous remote monitoring systems. Non-pharmacological interventions and audiovisual-assisted techniques are also discussed as potential strategies to reduce anesthesia requirements in selected patients. A multidisciplinary approach involving anesthesiologists, radiation oncologists, nurses, psychologists, and technical staff is essential to optimize safety, treatment adherence, and overall quality of care. Tailored anesthetic management, supported by standardized protocols and specialized pediatric expertise, remains crucial to balancing procedural efficacy with short- and long-term safety in this vulnerable population. Full article
(This article belongs to the Special Issue Anesthesia and Perioperative Management in Pediatrics)
15 pages, 473 KB  
Review
Advantages of Remimazolam in Pediatric Anesthesia: A Narrative Review
by Alessandro Vittori, Cecilia Di Fabio, Elisa Francia, Ilaria Mascilini, Riccardo Tarquini, Corrado Cecchetti, Giuliano Marchetti, Franco Marinangeli, Teresa Grimaldi Capitello and Marco Cascella
Children 2026, 13(3), 348; https://doi.org/10.3390/children13030348 - 27 Feb 2026
Viewed by 691
Abstract
Remimazolam is an ultra-short-acting benzodiazepine developed according to the “soft drug” concept and characterized by rapid onset, predictable offset, organ-independent metabolism, and the availability of a specific antagonist. Due to these pharmacological features, this drug represents a particularly attractive option for pediatric anesthesia [...] Read more.
Remimazolam is an ultra-short-acting benzodiazepine developed according to the “soft drug” concept and characterized by rapid onset, predictable offset, organ-independent metabolism, and the availability of a specific antagonist. Due to these pharmacological features, this drug represents a particularly attractive option for pediatric anesthesia and sedation, a field in which traditional agents are often limited by hemodynamic instability, prolonged recovery, and adverse respiratory effects. This narrative review summarizes and discusses the current evidence regarding the use of remimazolam in pediatric patients, focusing on pharmacokinetics, pharmacodynamics, clinical applications, and safety. Available data indicate that remimazolam provides effective sedation and anesthesia in children across multiple settings, including induction of general anesthesia, non-operating room anesthesia, and intensive care unit sedation. Compared with propofol and midazolam, remimazolam is generally associated with greater hemodynamic stability, rapid recovery, reduced emergence delirium, and a favorable respiratory profile, while maintaining comparable efficacy. Intranasal administration has also shown promise as a premedication strategy for reducing preoperative anxiety, although it may occasionally be associated with pain. Even if remimazolam lacks intrinsic analgesic properties, its use appears to indirectly improve postoperative comfort by attenuating stress responses and emergence agitation. Despite encouraging results, pediatric use of remimazolam remains off-label in many countries, and evidence is still limited by small sample sizes and heterogeneous protocols. Further large-scale randomized controlled trials are needed to define optimal dosing strategies, long-term safety, and their definitive role in pediatric anesthetic and sedative practice. Full article
(This article belongs to the Special Issue Anesthesia and Perioperative Management in Pediatrics)
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