Safe mechanical ventilation in pediatric anesthesia includes the use of protective ventilatory strategies. In anesthesia, the evidence-based literature is scarce and derives from intensive care and adult patients. New technologies, monitoring and knowledge of applied pathophysiology allow these data to be extrapolated. The technological advance in ventilators of the new anesthesia machines has allowed its use in smaller patients with greater safety, deploying more ventilatory modes for use in the operating room. The programming of the ventilator must be done looking for physiological objectives according to the stage of the child’s development, step of anesthesia and surgery, in a dynamic and individualized way. This narrative review aims to summarize the available evidence about intraoperative pediatric mechanical ventilation and provide practical clinical recommendations aimed at optimizing the performance of the anesthesia machine, applying safe ventilatory strategies in pediatric patients.