Vildan ERGEN, Eyüp HORASANLI
Türkiye Çocuk Hastalıkları Dergisi - 2026;20(4):302-308
The aim of this review is to present an integrated overview of pediatric perioperative anesthesia care by focusing on its fundamental components-preoperative evaluation, fasting management, prevention of postoperative nausea and vomiting (PONV), and postoperative pain control-based on current guidelines and evidence. The aim is to emphasize the need for individualized, risk-based approaches in pediatric patients. This study is designed as a narrative review based on current international guidelines and relevant literature on pediatric perioperative anesthesia. Key domains including preoperative assessment, fasting protocols, PONV prophylaxis, and postoperative pain management were evaluated within a comprehensive and integrated clinical framework. Emphasis was placed on risk stratification strategies, avoidance of unnecessary routine investigations, and the implementation of multimodal and age-appropriate approaches. Current evidence indicates that pediatric perioperative care differs significantly from adult practice due to limited physiological reserves, developmental variability, and age-related pharmacokinetic and pharmacodynamic differences. Risk-adapted strategies improve patient safety and outcomes. Specifically, shortened and evidence-based fasting protocols reduce metabolic stress; opioid-sparing multimodal analgesia minimizes adverse effects; risk-based antiemetic prophylaxis decreases the incidence of PONV; and age-appropriate pain assessment tools enhance postoperative pain management. Avoiding unnecessary routine tests further contributes to efficient and patient-centered care. Pediatric perioperative anesthesia care should be based on an integrated, individualized, and risk-oriented approach. The effective combination of optimized preoperative evaluation, evidence-based fasting strategies, tailored PONV prevention, and multimodal pain management improves safety and clinical outcomes. Current evidence strongly supports a shift from routine, standardized practices toward patient-specific, guideline-driven perioperative management in children.
