Update on total intravenous anesthesia in children

Pediatric TIVA is moving toward greater precision, safety, and sustainability. Moderate effect-site targets, opioid titration, and early down-titration remain central, particularly in neonates. Propofol infusion syndrome is exceedingly rare, and organ-protective effects of TIVA are reported in major surgery. Despite clinical and environmental advantages, adoption varies globally due to limited training, variable pump availability, and regulatory barriers. Expanding structured education and pediatric-specific TCI tools is essential for broader implementation.