Pediatric cardiac anesthesiologists care for patients ranging from premature infants weighing <2 kg to adults requiring surgical intervention for congenital heart disease. Along with their cardiac pathophysiologies, many of these patients also have other co-existing diseases that can affect their anesthetic management. Recent advances in monitoring include non-invasive neuromonitors, such as near-infrared spectroscopy and trans-cranial Doppler, which are assuming increasing importance in intraoperative management, particularly during cardiopulmonary bypass. A variety of anesthetic techniques, including regional anesthesia, can be used to facilitate early extubation in older infants and children with stable postoperative hemodynamics. In addition to regional anesthesia, other modalities for the management of postoperative pain include opioid infusions in critically ill children and the use of patient- or nurse-controlled analgesia pumps. Multiple pain assessment tools are available for children of varying ages and developmental levels to assist in providing appropriate postoperative pain management.