Safe Surgery Starts With Safe Anesthesia: Positioning Pediatric Anesthesia as a Core Health-System Function Within...

Children's surgery is increasingly recognized as a global health priority, yet pediatric anesthesia remains comparatively under-recognized despite being essential for safe surgical and perioperative care.

Children require specialized expertise, age-appropriate equipment, reliable monitoring, oxygen, medicines, recovery, and critical care. In many low- and middle-income countries, deficiencies across these domains limit access and contribute to preventable perioperative morbidity and mortality.

We posit that children's surgical systems cannot be strengthened without parallel investment in pediatric anesthesia systems. Pediatric anesthesia should therefore be recognized as a cross-cutting core health-system function rather than a supporting clinical specialty.

This perspective integrates the WHO Health Systems Building Blocks, the Lancet Commission on Global Surgery, National Surgical, Obstetric and Anesthesia Plans, the GICS Optimal Resources for Children's Surgery framework, and Donabedian's Structure-Process-Outcome model into an Integrated Pediatric Anesthesia Systems Framework (IPASF).

Governments, professional societies, academic institutions, global surgery organizations, and development partners should integrate pediatric anesthesia into surgical-system planning, workforce development, financing, service delivery, quality improvement, and research.

Safe and equitable children's surgery requires deliberate investment in the systems that enable safe anesthesia. The IPASF provides a practical framework for policy, implementation, education, research, and evaluation across the perioperative continuum.