Promoting safe anaesthesia for every child: the SAFETOTS initiative and beyond

Purpose of the review Paediatric anaesthesia has achieved remarkable progress over recent decades, yet contemporary data reveal that safety remains unevenly distributed across age groups, institutions, and regions of the world. Recent findings Large observational studies demonstrate persistent perioperative morbidity and mortality, particularly in neonates, infants, and children cared for in resource-limited settings. While these multicentric investigations did not establish a direct causal relationship between anaesthetic management and perioperative morbidity or mortality in paediatric populations, they did reveal a high incidence of critical events related to the conduct of anaesthesia, which, if not diagnosed in time or left uncorrected, could lead to catastrophic outcomes. Summary The Safe Anaesthesia for Every Tots (SAFETOTS) initiative focuses on the safe conduct of anaesthesia, maintenance of perioperative physiological stability, alongside organisational and child-centred values in perioperative care. This review explores the current state of and challenges in paediatric anaesthesia safety through the perspective of the SAFETOTS initiative.