Children are not little adults: a special issue on pediatric anesthesia

When discussing pediatric patients, many experts emphasize the phrase, "Children are not small adults" [1,2].Approximately six centuries ago, European painters depicted children as miniature adults (Fig. 1A).However, during the Renaissance period, artists realized that children were not simply scaled-down adults.As seen in Raphael's Madonna and Child (Fig. 1B), children were portrayed as having large heads, long torsos, and short limbs.Today, it is well known that pediatric patients exhibit both physical and physiological differences and vulnerabilities [3].Approximately six million pediatric patients undergo general anesthesia annually, of which 25% are infants [4].The first pediatric anesthesia was administered in 1842, with doctors at that time recognizing that children experienced different anesthesia-related complications to those of adults [5].Although all anesthesiology residents receive specialized training in areas such as pediatric anesthesia, and efforts to improve patient safety have reduced anesthesia-related mortality from 1:2,500 to 1:13,000 over the past 50 years [6,7], perioperative care of pediatric patients remains challenging and often requires a dedicated pediatric anesthesia care team [8].This special issue of Anesthesia and Pain Medicine (APM) on 'Pediatric Anesthesia' follows the 19th Conference of the Asian Society of Pediatric Anesthesiologists (ASPA 2023), held in conjunction with the 31st Annual Meeting of the Korean Society of Pediatric Anesthesiologists that took place in Seoul, South Korea, from June 16-18, 2023.Under the overarching theme of 'Equity and Quality in Pediatric Anesthesia,' this conference featured a world-class program with globally renowned experts in the field of pediatric anesthesia.Over 80 speakers from 20 countries delivered 84 lectures, some of which were included in special issues.Following the success of the conference, paper submissions were invited in the fall of 2023.After receiving diverse manuscripts from around the world and subjecting them to rigorous peer review, > 10 articles were published.The aim of this special issue is to gather scholarly and practical insights into pediatric anesthesia, providing a wide range of academic and clinical knowledge for pediatric anesthesiologists, as well as clinicians who find pediatric anesthesia challenging.Goal-directed monitoring has already been established in adults; however, some monitoring devices used in pediatric patients have not been validated in children or are limited by size.Although short-term anesthesia is harmless for healthy children, it remains unclear whether the same holds true for high-risk neonates and infants undergoing mul-