The application of robotic surgery in pediatric patients presents a significant anesthetic challenge because of the peculiar anatomical and physiological characteristics of this population. This chapter will explore the anesthetic management during pediatric robotic surgery, with an in-depth analysis of the effects of pneumoperitoneum and patient extreme positioning on the respiratory, cardiovascular, neuroendocrine, and splanchnic systems. Specifically, it will explore ventilation strategies needed to counteract reduced lung compliance and ventilation-perfusion mismatch, cardiovascular adaptations to increase intra-abdominal pressure, and fluid homeostasis. The anesthesiologist’s role throughout the entire perioperative course will also be discussed, from patient selection and preoperative risk assessment to meticulous intraoperative monitoring of airway management, neuromuscular blockade, and the maintenance of hemodynamic and thermal stability. Moreover, the chapter will address the anesthetic management of postoperative pain using multimodal analgesia, as well as strategies for the prevention of postoperative nausea and vomiting (PONV) and short-term complications such as gas embolism or respiratory compromise. In conclusion, the aim of this chapter is to highlight the critical importance of comprehensive anesthetic planning, patient-centered perioperative care, and interdisciplinary collaboration among surgical team members to optimize outcomes and minimize perioperative morbidity in pediatric patients undergoing robotic surgery.