In this issue of Pediatric Clinics of North America, guest editors Drs. Moises Auron and Mirna Giordano bring their considerable expertise to the topic of Perioperative Management and Optimization of the Pediatric Patient with Complex Medical Needs. Top experts address common physiologic considerations in the perioperative period in most patients with complex medical issues, and discuss specific patient populations (e.g. patients with ventriculoperitoneal shunts), providing the information and tools needed by pediatric clinicians to update their assessments and mitigate risk factors.