Anesthesia in neonates and infants under one year of age presents unique challenges to anesthesiologists due to the profound anatomical, physiological, and pharmacological differences between this age group and older children or adults. This article provides a comprehensive review of the critical clinical and physiological characteristics that dictate anesthetic management in early infancy. We examine the immature respiratory, cardiovascular, renal, and central nervous systems, highlighting how these factors influence the pharmacokinetics and pharmacodynamics of commonly used anesthetic agents. Furthermore, the discussion focuses on recent clinical trial insights regarding neurotoxicity, intraoperative monitoring, and specialized airway management strategies. Understanding these distinctive variables is paramount to minimizing perioperative morbidity and mortality, optimizing surgical outcomes, and ensuring neurodevelopmental safety in this vulnerable patient population.