Objective To review and analyze perioperative anesthesia management and complications of child patients with craniostenosis who underwent cranial vault reconstruction, and summarize the key points of perioperative anesthesia management and improve clinical prognosis and safety. Methods The medical records of child patients with craniosynostosis who underwent surgery from January 2016 to December 2021 were retrospectively collected. Their demographic data, laboratory examination results, perioperative anesthetic management and postoperative complications were analyzed. Results A total of 32 children with craniostenosis were analyzed, with the age of (18±9) months. There were 20 boys (62.5%) and 12 girls (37.5%). The mean intraoperative blood loss was (44±24) ml/kg, and the mean intraoperative minimum hemoglobin level was (85±21) g/L. Autologous blood salvage was used in 21 cases (65.5%), while 31 patients (96.9%) were transfused with allogeneic blood products. Furthermore, 23 patients (71.9%) experienced intraoperative hypotension, and even 7 patients (21.9%) suffered from hypovolemic shock. Anaphylactic shock occurred in 1 patient (3.1%) due to transfusion of blood products，delayed recovery in 5 patients (15.6%), and delayed extubation in 3 patients (9.4%). After surgery, there were 26 cases (81.3%) of anemia to various degree, 5 cases (15.6%) of coagulation disorder, and 9 patients (28.1%) were infused with concentrated red blood cells or freshly frozen plasma. Moreover, there were 6 cases (18.8%) of electrolyte disorder, 2 cases (6.3%) of pulmonary infection, 1 case (3.1%) of postoperative wound infection, 2 cases (6.3%) of subdural hematoma, and 1 case (3.1%) of reoperation. Conclusions For child patients with craniostenosis, their perioperative complications after cranial vault reconstruction are mainly massive bleeding, hypotension, and coagulation disorders due to large volumes of blood transfusion. Comprehensive measures of blood protection, timely coagulation monitoring, and active perioperative management are crucial for reducing blood transfusion rate, maintaining perioperative circulation stability, and ensuring surgical safety and quality.