[Update on the practical use of new anesthetic agents]

Most drugs used in practical pediatric anesthesia are off-label. Pediatric anesthesiologists and non-pediatric anesthesiologists who rarely encounter pediatric patients need to be aware of the clinical usage of these drugs based on pediatric pharmacokinetics and pharmacodynamics to ensure that children are not exposed to unnecessary risks. Clinical guidelines on anesthetic drugs have been made available on the Japanese Society of Anesthesiologists website, and anesthesiologists are encouraged to access this site at least once. Propofol is commonly used in pediatric anesthesia and sedation in several situations. However, we should always consider the possibility of propofol infusion syndrome in the case of long-term administration. Rocuronium is widely used for general anesthesia in elective surgeries, examinations, and minor procedures in pediatric patients. Rocuronium can be used for rapid sequence induction, taking into consideration the dose and duration of action. Sugammadex has recently been introduced for practice in Japan. Rocuronium and sugammadex have been used safely in pediatric patients so far, and may change the induction methods used in difficult airway patients and the management of airway emergencies. Desflurane is novel in Japan and has not been commonly used in pediatric anesthesia. Desflurane may cause very high irritability in the airway and may be used for the maintenance of anesthesia in limited situations.