Critical Elements for the Pediatric Periprocedural Anesthesia Environment
Lynne G. Maxwell MD
As we have discussed in previous PAADs here the American Academy of Pediatrics provides guidance for pediatricians and pediatric subspecialists with respect to the safe delivery of care to pediatric patients. One important topic has been the appropriate and necessary components for safe delivery of anesthetic care. The focus of today’s PAAD is the recent AAP policy statement delivered by Long et al, members of the AAP Section on Anesthesiology and Pain Medicine, written with input from other members of the Section and liaisons to the Section from SPA and SPPM.1
Original article
Long JB, Houck CS, Varughese AM; Section on Anesthesiology and Pain Medicine. Critical Elements for the Pediatric Periprocedural Anesthesia Environment: Policy Statement. Pediatrics. 2026 Mar 1;157(3):e2025075746. doi: 10.1542/peds.2025-075746. PMID: 41724193.
In this policy statement “The American Academy of Pediatrics proposes guidance for the pediatric periprocedural anesthesia environment. Essential components are identified to optimize the periprocedural anesthesia environment for the anesthetic care of infants and children. Such an environment promotes the safety and well-being of infants and children by reducing the risk of adverse events.”
Because of the well-known increased risk of perioperative morbidity and mortality in infants younger than 1 year and children with complex comorbidities, it ahs been recommended that anesthesia care for these populations be delivered by pediatric fellowship-trained anesthesiologists in facilities with neonatal and pediatric critical care units. However, in addition to these personnel concerns, other elements of the facility-based resources are important for safe and successful outcomes. These resources include personnel, equipment and supplies appropriate for this patient population.
Components that require attention and compliance include
· Clinical privileges of physician anesthesiologists including fellowship training and ongoing experience sufficient to maintain competence
· Designation of high risk populations requiring these specialized anesthesiologists by age, comorbidities, high risk procedures
· Appropriate training and ongoing experience of pediatric advanced practice providers in anesthesia team roles
· Availability and appropriateness of acute pain management including the establishment of an opioid stewardship program
· Anesthesia Quality Improvement Programs
· Pediatric specific patients care units
o Preoperative evaluation and preparation
o Periprocedural anesthesia environment including operating rooms, clinical laboratories, blood bank and radiology services, pediatric anesthesia equipment and drugs
· Postanesthesia care unit including appropriate equipment and trained, experienced nursing staff, and other staff including respiratory therapy and child life. (The authors include a useful table of necessary equipment for the procedure area and PACU
· Postoperative inpatient care
Astute observers will note the similarity between the recommendations of Long et al and the standards set forth by the American College of Surgeons Children’s Surgical Verification Program (CSV).2 This is no coincidence as many long-time AAP Section and SPA leaders have played a role in the genesis of the CSV standard, including Constance Houck and Jay Deshpande.
Those of you working at institutions who have gone through the CSV accreditation process are very familiar with these standards and therefore the components of this policy statement should be very familiar to you. The availability of the more concise AAP statement highlighted in today’s PAAD may be useful to those of you practicing in environments where some of these resources may be lacking, if you would like to advocate to your departmental/hospital administration for the resources and personnel needed to achieve safe and satisfactory perioperative outcomes.
Send your thoughts and comments to Myron (myasterster@gmail.com) and he will post in a Friday reader response.
References
1. Long JB, Houck CS, Varughese AM; Section on Anesthesiology and Pain Medicine. Critical Elements for the Pediatric Periprocedural Anesthesia Environment: Policy Statement. Pediatrics. 2026 Mar 1;157(3):e2025075746. doi: 10.1542/peds.2025-075746. PMID: 41724193.
2. Optimal Resources for Children’s Surgical Care: American College of Surgeons Task Force for Children’s Surgical Care. Accessed May 5, 2026. https://www.facs.org/media/ea0nna5w/2021_optimal_resources_for_childrens_surgical_care.pdf