Pediatric anesthesia as a navigator: current practice and hot topics in preoperative assessment

PURPOSE OF REVIEW: Preoperative assessment is a central but increasingly complex component of pediatric anesthetic care. While perioperative safety in children has improved substantially, preventable complications remain prevalent. This review examines current concepts of pediatric preoperative evaluation, highlights emerging trends and controversies, and proposes the concept of anesthesia as a perioperative "navigator", whose guiding function begins with preoperative assessment. RECENT FINDINGS: Contemporary practice of preoperative assessment increasingly includes structured risk stratification, procedure-specific planning, optimization of modifiable risk factors, and family centered communication. Advances highlight shorter fasting regimens, growing implementation of methods to optimize preexisting or chronic conditions such as pediatric patient blood management, refined strategies to manage upper respiratory tract infections and individualized approaches to manage preoperative anxiety. At the same time, digitalization, remote preassessment models, and delegation of assessment tasks are shaping clinical workflows. Shared decision-making and proactive communication have emerged as key determinants of cooperation for children and their families. SUMMARY: Modern pediatric preoperative evaluation should be viewed less as a static medical checkpoint and more as starting for the dynamic process of perioperative "navigation". Integrating medical risk assessment with structured planning and effective communication remains essential to reduce complications and improve both safety and experience in pediatric anesthesia.