We miss one of the most exciting moments of our lives – our birth. From that first day on, humans learn and accumulate experiences and dream about great things to come. It is a pediatric anesthesiologist's honor and pleasure to be present with families and children during one of the most important events of their lives: when they travel through our perioperative domain. When patients travel through the adult perioperative domain, we often hear them (and those who care for them) complain of feeling as if they were cogs in a machine, like passing on a conveyor through a fast-food restaurant. For pediatric patients, those who care for them make the journey more tolerable, even fun, through song, silly voices and puppets, virtual reality, and games. The hospitals where children are cared for may have a similar corporate feel, but they are more like brightly colored restaurants with animals, fun food, and a bouncy ball pit. Just don't forget to wash your hands!

As President of the Society for Pediatric Anesthesia (SPA), I am proud to underscore the organization's contributions. Founded in 1986 by Myron Yaster, MD, the SPA serves to advance the safety and quality of anesthesia care, perioperative care, and pain management in children through education endeavors, by supporting research, and by fostering collaboration among clinicians, patient families, and professional organizations worldwide (pedsanesthesia.org). The first SPA meeting was held in October 1987, and a growing membership now supports two events annually. The most recent meeting had over 1,275 attendees, with 80% in person. The current SPA membership numbers nearly 4,000. Membership is complimentary for residents and medical students and is sharply discounted for pediatric anesthesiology fellows and international trainees.

Approaching our 40th anniversary, the SPA has matured as an organization and expanded our mission beyond the lectures, workshops, and networking opportunities of meetings. New avenues include innovations to improve clinical care, global initiatives, and greater investments in pediatric anesthesia research. The complexity of managing pediatric anesthesia groups spurred the creation of the Pediatric Anesthesia Leadership Council (PALC), which gathers division chiefs, both academic and nonacademic, from large programs and small, to learn from each other and to provide mutual support. The Congenital Cardiac Anesthesia Society (CCAS) and the Society for Pediatric Pain Medicine (SPPM) are two vibrant and growing component organizations that hold successful spring meetings, attracting many participants for updates on the state of the art in their subspecialties (ccasociety.org; pedspainmedicine.org). Check out their webinars and the educational content on their websites!

The Pediatric Anesthesiology Fellowship is the foundation for the future of perioperative care for children. The fellowship was approved by the Accreditation Council for Graduate Medical Education in 1997, and the American Board of Anesthesiology offered the certifying examination in pediatric anesthesiology in 2013. The complexities of this evolving educational environment prompted the formation of the Pediatric Anesthesiology Program Directors' Association to promote advanced clinical training in perioperative care for pediatric patients. Over the last several years, there have been substantial pressures on our pediatric anesthesiology training programs, as many have not filled in the match. All anesthesia fellowships are encountering market pressures and a reluctance of residents to pursue advanced training. To counter this trend, the SPA performed a Delphi study to identify and develop a pathway to improve all aspects of pediatric anesthesia training (Anesth Analg 2023;136:437-45). The SPA is creating initiatives to attract and recruit trainees, and we anticipate the Delphi-guided roadmap will benefit our trainees for years to come.

The SPA is committed to the future of its trainees, its members, and our patients. The SPA developed the Pedi Crisis checklists, available for free in multiple languages, to guide the management of pediatric emergencies. This evolved into the Pedi Crisis app, which is available for free in English and Spanish for Apple and Android platforms (asamonitor.pub/3sY3om2). Both the app and checklists are continually updated by a standing SPA committee. Since 2016, the SPA Young Investigator Research Grant has given up to $100,000 of annual seed grant funding to support young researchers. The SPA donates $15,000 of annual support to both SmartTots and the Foundation for Anesthesia Education and Research. SPA Global focuses our international efforts to help enhance the perioperative care of children worldwide. The SPA collaborates with the World Federation of Societies of Anaesthesiologists to support two pediatric anesthesiology fellows, one in Kenya and the other in Thailand, as an ongoing commitment to develop the talent pool of the future. Since 2018, the SPA has sponsored a Distinguished International Scholar, bringing world leaders in pediatric anesthesia to attend the spring SPA meeting and expand our global outreach.

The wellness of our pediatric anesthesiologists, both in training and in practice, is as essential as advocating for their concerns. Women physicians confront particular challenges, and the SPA Women's Empowerment and Leadership Initiative (WELI) is an impactful mentoring program to empower and support women pediatric anesthesiologists (weli.pedsanesthesia.org). In 2018, the SPA Committee on Diversity, Equity and Inclusion was created to address often unmet concerns of members as well as children and families for whom we care. A Well-Being Committee was created to provide better care for our members and to strive to create a better environment for our fellows and residents to train and eventually join us as colleagues.

It has been said that the true measure of any society can be found in how it treats its most vulnerable members. Every day, pediatric anesthesiologists care for fragile children and their struggling families in their times of need. The opportunity to care for a child, to be there with their family, and to make their journey easier is a noble calling. It is also a recipe for a happy life that we hope many of our residents and students will embrace. I would like to express my gratitude to the ASA Monitor for the opportunity to share an update about the SPA and the wonderful world of pediatric anesthesiology.

Jim Fehr, MD, FAAP, President, Society for Pediatric Anesthesia, Anesthesiologist-in-Chief, Lucile Packard Children's Hospital, and Clinical Professor of Anesthesiology and Pediatrics, Stanford University School of Medicine, Palo Alto, California.

Jim Fehr, MD, FAAP, President, Society for Pediatric Anesthesia, Anesthesiologist-in-Chief, Lucile Packard Children's Hospital, and Clinical Professor of Anesthesiology and Pediatrics, Stanford University School of Medicine, Palo Alto, California.

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