Search Results (167)

Background: Prolonged extubation and pain following cardiac surgery remain significant clinical challenges. The pecto-intercostal fascial plane block (PIFB) is an emerging regional anesthesia technique incorporated into multimodal analgesia protocols to reduce opioid consumption and facilitate early extubation. This study retrospectively evaluated extubation times, perioperative opioid consumption, and postoperative analgesic requirements in patients who underwent isolated open-heart surgery via median sternotomy, comparing those who received PIFB with those who did not. Methods: This retrospective single-center study included ninety-nine patients who underwent isolated on-pump coronary artery bypass graft surgery via median sternotomy between 1 June 2023 and 25 March 2024. The study included 46 patients who received PIFB (Group 1) and 53 patients who received no block (Group 2). Ultrasound-guided bilateral PIFB was performed after anesthesia induction, with a total of 40 mL administered to each side (30 mL 0.25% bupivacaine + 10 mL normal saline). Demographic data, perioperative data, extubation times, analgesic consumption, and complications were compared between groups. Results: Demographic data, EuroSCORE, body mass index, and ejection fraction were similar between groups. Perioperative opioid (fentanyl) consumption was statistically significantly higher in Group 2 (median 450 [IQR: 350–600] μg vs. 400 [IQR: 350–450] μg; p = 0.037). Extubation time was statistically significantly shorter in Group 1 compared to Group 2 (median 340 [IQR: 265–490] min vs. 495 [IQR: 420–555] min; p < 0.001). The number of patients requiring postoperative paracetamol and tramadol was statistically significantly lower in Group 1 (p = 0.015 and p < 0.001, respectively). No statistically significant difference was found between groups regarding chest drain removal, length of hospital stay, or ICU length of stay (p > 0.05). Mortality occurred in 1 patient in Group 1 and 2 patients in Group 2. Conclusions: PIFB application in isolated open-heart surgery performed via median sternotomy was associated with shorter extubation time and reduced perioperative fentanyl and postoperative analgesic consumption, without a statistically significant effect on hospital length of stay. Complication and mortality data are reported descriptively; the study does not have sufficient statistical power to draw inferences regarding safety outcomes. Full article

Background and Objectives: Controlled hypotension during functional endoscopic sinus surgery (FESS) improves surgical field visibility but may pose a risk of subclinical cerebral hypoperfusion. Serum S100Β and neuron-specific enolase (NSE) are established biomarkers of glial and neuronal injury and may reflect perioperative neuroprotection associated with different anesthetic regimens. This study evaluated the effect of four anesthetic protocols on perioperative brain biomarker release during FESS. Materials and Methods: In this single-center, randomized, controlled trial, 88 adult patients (ASA I–III) undergoing FESS under moderately controlled hypotension (mean arterial pressure < 55 mmHg) were allocated to one of four groups: propofol–remifentanil, propofol–remifentanil with ketamine–magnesium, sevoflurane–remifentanil, or sevoflurane–remifentanil with ketamine–magnesium. Serum S100Β and NSE concentrations were measured at three timepoints: early intraoperatively, during hypotension, and at the end of surgery. Biomarker data were analyzed using nested ANOVA and linear mixed-effects models adjusted for relevant covariates. Secondary outcomes included recovery characteristics, surgical field quality, bleeding scores, and perioperative hemodynamics. Results: Baseline demographic and perioperative characteristics were comparable across groups. The group receiving sevoflurane–remifentanil combined with ketamine–magnesium showed the lowest S100B levels (p = 0.01 compared to the propofol–remifentanil group; p = 0.04 compared to the sevoflurane–remifentanil group). Additionally, NSE concentrations were markedly lower in both sevoflurane groups (sevoflurane–remifentanil and sevoflurane–remifentanil plus ketamine–magnesium) compared to the propofol–remifentanil group (p = 0.003 and p = 0.007, respectively). No intergroup differences were observed at baseline and surgical field quality, bleeding, and hemodynamic parameters did not differ significantly among groups. Recovery and extubation times were shortest with propofol–remifentanil, whereas ketamine–magnesium prolonged emergence. Conclusions: Anesthetic technique significantly influences perioperative brain biomarker release during FESS. Sevoflurane-based regimens, with or without ketamine–magnesium, demonstrate more favorable neurobiological profiles under controlled hypotension, although propofol-based anesthesia offers faster recovery. Full article

Background/Objectives: Postoperative agitation (PA) and postoperative pain in pediatric patients following sevoflurane anesthesia are challenging clinical scenarios. This study aimed to evaluate the effects of intraoperative dexmedetomidine infusion compared to fentanyl infusion on the prevention of postoperative agitation and analgesic efficacy in children undergoing tonsillectomy and/or adenoidectomy. Methods: After ethical committee approval, a total of 85 pediatric patients (age range: 2–13 years) in the ASA I-II group were included in the study. Patients were randomized into two groups: the dexmedetomidine group (Group D, n = 40) and the fentanyl group (Group F, n = 45). Postoperative pain was monitored in the recovery unit (PACU) using the FLACC (face, legs, activity, cry, consolability) scale, and agitation was monitored using the PAED (pediatric anesthesia emergence delirium) scale. FLACC and PAED were monitored at 5, 10, 15, 30 min, and 2 and 4 h postoperatively. Results: Demographic data and surgical durations were similar between groups (p > 0.05). The dexmedetomidine group had lower FLACC pain scores at 10 and 15 min (uncorrected trends), but only the difference at 30 min remained statistically significant after Bonferroni correction (p = 0.0001; Cohen’s d = 0.85). Although PAED scores were numerically lower in Group D, no statistically significant difference was found. While an observational trend toward lower agitation was noted, it did not reach statistical significance. Extubation times and hemodynamic parameters were similar in both groups. Conclusions: The intraoperative use of dexmedetomidine in tonsillectomy and adenoidectomy procedures provides superior analgesia compared to fentanyl, particularly in the first 30 min postoperatively, without prolonging recovery time. Full article

Background and Clinical Significance: COVID-19 may worsen in patients receiving immunosuppressants. Furthermore, drug–drug interactions and concomitant use of anti-inflammatory drugs complicate treatment. We report the clinical course of severe COVID-19 pneumonia in a 74-year-old Japanese male kidney transplant recipient. Case Presentation: The patient had been taking tacrolimus (TAC) (2.5 mg/day), mycophenolate mofetil (1000 mg/day), and prednisone (5 mg/day) since his kidney transplant 7 years earlier. Twenty days before admission, he tested positive for SARS-CoV-2 antigen and was administered molnupiravir for 5 days. At admission, real-time PCR testing of a nasopharyngeal specimen revealed high viral loads, with Ct values of 22.2 and 27.9 for the E and N2 genes, respectively. An oxygen flow rate of 15 L/min was required to maintain arterial oxygen saturation above 90%. TAC was continued, and antibiotics, steroids, anti-interleukin-6 receptor antibodies, intravenous immunoglobulin, and ensitrelvir (ESV) were administered. With invasive positive-pressure ventilation, positive end-expiratory pressure (PEEP), and prone positioning, the arterial oxygen tension/inspired oxygen tension (P/F) improved from 61.3 to 386 within 7 h. The patient was extubated 30 h after admission. The TAC dose was adjusted from 2.5 mg/day to 1 mg/day to achieve the target trough level. The patient was discharged on hospital day 8. PCR testing at discharge showed a decrease in viral load. Conclusions: This study provides insights into the treatment of COVID-19 in patients receiving immunosuppressants. Combination therapy of ESV and TAC was feasible in kidney transplant recipients with dose adjustment. The use of other anti-inflammatory drugs should also be considered. Full article

Background: Sarcopenia is highly prevalent in end-stage liver disease and is associated with adverse perioperative outcomes. However, its association with rocuronium pharmacodynamics during liver transplantation (LT) remains insufficiently defined. Aim: This study aimed to evaluate the association between sarcopenia, neuromuscular blockade kinetics, and clinical outcomes in LT recipients. Methods: In this prospective observational cohort study, 139 adult LT recipients were classified as sarcopenic (n = 70) or non-sarcopenic (n = 69) based on EWGSOP2 criteria, including SARC-F, handgrip strength, and psoas muscle index (PMI). Rocuronium (1 mg/kg, ideal body weight) was administered at induction, and quantitative neuromuscular monitoring was performed using train-of-four (TOF). The primary outcome was time to complete neuromuscular blockade (T0). Secondary outcomes included intraoperative neuromuscular recovery parameters, perioperative clinical variables, and postoperative outcomes. Multivariable GLM analyses were performed to evaluate factors associated with sarcopenia and T0, while logistic regression models were used to assess factors associated with mortality. Results: Sarcopenic patients exhibited significantly reduced PMI (p < 0.001) and lower handgrip strength (p = 0.001). In the baseline binomial-logit GLM, age was independently associated with sarcopenia (OR = 1.034, p = 0.025). The onset of neuromuscular blockade was significantly prolonged in the sarcopenic group (T0: 100 vs. 80 s; p < 0.001). In the adjusted Gamma regression model, sarcopenia remained significantly associated with longer T0 after adjustment for age, sex, MELD score, BMI, and hemoglobin level (adjusted ratio = 1.232, 95% CI: 1.105–1.372, p < 0.001). Postoperatively, they demonstrated prolonged extubation time (10 vs. 7 h; p < 0.001), extended ICU stay (9 vs. 6 days; p < 0.001), and higher mortality (27.1% vs. 8.7%; p = 0.009). In multivariable logistic regression, sarcopenia was independently associated with mortality (OR = 3.26; p = 0.023), while each additional ICU day was associated with an approximate 9% increase in mortality risk in the secondary model. Conclusions: Sarcopenia was associated with altered rocuronium pharmacodynamics in LT recipients, primarily characterized by delayed onset of complete neuromuscular blockade, and this association persisted after adjustment for age and other baseline clinical variables. Sarcopenic recipients also showed prolonged extubation time, longer ICU stay, and higher mortality. These findings support the integration of sarcopenia into perioperative risk stratification and individualized neuromuscular management strategies in this high-risk population. Full article

Background: Magnesium sulfate (MgSO₄) has been investigated as an adjuvant in perioperative analgesia because of its antagonistic effects on the N-methyl-D-aspartate receptor (NMDA receptor) and its potential to attenuate central sensitization. However, clinical findings regarding its analgesic efficacy remain inconsistent across surgical procedures. Lumbar microdiscectomy is a common spinal procedure in which effective early postoperative pain control is important for patient comfort and early mobilization. This study aimed to evaluate the effect of intraoperative MgSO₄ administration on early postoperative analgesia and perioperative outcomes in patients undergoing lumbar microdiscectomy. Methods: This retrospective single-center cohort study included thirty-eight patients with American Society of Anesthesiologists (ASA) physical status I–II who underwent elective single-level lumbar microdiscectomy under general anesthesia. Patients were divided into two groups according to intraoperative magnesium administration: a control group receiving standard anesthesia without MgSO₄ (n = 19) and an MgSO₄ group receiving an intravenous MgSO₄ bolus of 30 mg/kg followed by a continuous infusion of 10 mg/kg/h until skin closure (n = 19). Postoperative pain intensity was assessed using the Numeric Rating Scale (NRS) at 0, 5, 10, 15, and 30 min after admission to the post-anesthesia care unit. Secondary outcomes included intraoperative remifentanil consumption, extubation time, and time to first mobilization. Complementary in silico analyses included molecular docking and protein–protein interaction (PPI) network analysis. Results: Postoperative NRS scores were numerically lower in the MgSO₄ group; however, between-group differences were not statistically significant. Mean intraoperative remifentanil consumption was numerically lower in the MgSO₄ group (236 ± 166 µg) compared with the control group (319 ± 298 µg), without statistical significance (p = 0.27). Repeated-measures analysis demonstrated the significant effect of time on postoperative NRS scores, whereas the overall group effect was not significant. Molecular analyses indicated stable morphine binding to opioid receptors and highlighted glutamatergic signaling components as central nodes within the interaction network. Conclusions: Intraoperative MgSO₄ administration was not associated with significant improvements in early postoperative pain scores or perioperative recovery parameters following lumbar microdiscectomy. Molecular analyses provide exploratory in silico insights and should be interpreted cautiously given the retrospective design and the in silico nature of these findings. Full article

Background/Objectives: Determining the optimal timing for the discontinuation of mechanical ventilation (MV) in pediatric patients following cardiac surgery remains challenging. Both delayed and premature extubation increase the risk of complications. The rapid shallow breathing index (RSBI) is widely used, but its role and optimal cutoff in pediatric cardiac populations remain uncertain. This study aimed to determine a clinically useful RSBI cutoff for predicting extubation readiness in children after cardiac surgery. Methods: We conducted a prospective single-center observational cohort study including children younger than 18 years who required postoperative MV after cardiac surgery and were admitted to the Pediatric Intensive Care Unit (PICU) between July 2020 and June 2024. The RSBI was measured one minute prior to extubation during a spontaneous breathing trial (SBT). Extubation failure was defined as the need for reintubation within 48 h. Results: A total of 247 patients were enrolled, with 13 (5.3%) experiencing extubation failure. Patients who failed extubation had significantly higher RSBI values compared with those successfully extubated (median 4.97 vs. 3.76; p < 0.001). An RSBI cutoff ≥ 4.62 breaths/min/mL/kg provided a sensitivity of 84.6%, specificity of 94.0%, positive predictive value (PPV) of 44%, and negative predictive value (NPV) of 99.1%. The RSBI was the only independent predictor of extubation failure in multivariable analysis (p = 0.014). Conclusions: The RSBI is a simple and reliable physiological marker for assessing extubation readiness in pediatric patients after cardiac surgery. An RSBI threshold of ≥4.62 breaths/min/mL/kg identifies patients at increased risk of extubation failure. Larger, multicenter studies will be important to validate our results. Full article

Objectives: Recently, there has been a growing interest in repairing congenital heart defects in children via right axillary thoracotomy. We sought to review our experience with ventricular septal defect closure through this approach. Patients and Methods: This is a retrospective single-center analysis of 50 children who underwent closure of ventricular septal defects via vertical right axillary thoracotomy between March 2018 and February 2024. We reviewed the patients’ characteristics, perioperative and follow-up data. Results: The study included 26 (52%) girls with a median age of 7 (1–132) months. All patients underwent vertical right axillary thoracotomy with no conversion to sternotomy. Membranous ventricular septal defect was the most common diagnosis and was present in 43 (89%) patients. The median cardiopulmonary bypass and aortic cross clamp times were 96.5 (47–157) and 73 (30–114) min, respectively. In 45 (90%) of the patients, a patch was used. No early or late mortality. All patients were extubated in the operating room, and the median length of hospital stay was 2 (1–321) days. One early reoperation for bleeding, and one patient needed a permanent pacemaker. No late reoperations and all patients/parents were pleased with the incision. Conclusions: The outcomes of the right axillary thoracotomy for repairing ventricular septal defects in children are excellent. The approach is safe and is associated with superior cosmetic results and very short hospital stay. It should be strongly considered as an alternate to sternotomy for closure of ventricular septal defects. Full article

Objective: The objective of this study was to choose the optimal anesthesia method for gastric cancer patients undergoing surgery with lymph node dissection. Materials and Methods: The study included 53 patients with stage T1-4aN0-3M0 gastric cancer, who underwent radical surgery with xenon and dexmedetomidine (DMM) anesthesia in combination with epidural analgesia (main group, 27 patients) or with sevorflurane anesthesia in combination with epidural analgesia (comparison group, 26 patients). All patients underwent monitoring of hemodynamic parameters, blood coagulation system, thromboelastometry, and inflammation and metabolic parameters (interleukins, hormones and glucose levels), with an assessment of complications according to the Clavien-Dindo classification and the intensity of postoperative pain. Results: Awakening and extubation times, narcotic analgesic consumption, and Numeric Rating Scale pain scores were lower in the xenon + DMM group than in the sevoflurane group (p < 0.05). The overall number of patients experiencing complications did not differ significantly between anesthesia types; however, significant differences were found in the total number of complications (p = 0.003), the number of complications according to Clavien-Dindo I (p = 0.043) and II (p = 0.019), and the incidence of postoperative nausea and vomiting (p = 0.042). Conclusions: The BIS monitoring data obtained showed a sufficient level of anesthesia depth during surgery in both groups; however, post-anesthesia depression persisted longer in patients in sevoflurane group. Mathematical models for predicting Clavien-Dindo IIIb-V complications and severe postoperative pain syndrome are characterized by high sensitivity and specificity. They include simple clinical and laboratory parameters as well as type of anesthesia as predictors. The limitations of predictive models are also discussed in the article. Full article

Background/Objectives: Emergence agitation (EA) is common after rhinologic surgery and may cause self-injury, bleeding, and prolonged post-anesthesia care unit (PACU) stay. Remimazolam is an ultra-short-acting benzodiazepine that may reduce EA without delaying recovery. The objective of this study was to evaluate the effect of a single dose of remimazolam administered at the end of surgery on the incidence of EA in adult patients undergoing nasal surgery. Methods: In this prospective, randomized, triple-blind, placebo-controlled trial, 62 adults undergoing elective rhinologic surgery under sevoflurane anesthesia received either remimazolam 0.1 mg/kg or saline immediately after sevoflurane discontinuation and before extubation. EA was assessed using the Richmond Agitation–Sedation Scale (RASS) at extubation and every 5 min for 30 min in the PACU. The primary outcome was presence of EA (RASS ≥ 2) at extubation. Secondary outcomes included Aldrete recovery scores, VAS, PONV incidence and safety outcomes. The study was registered at ClinicalTrials.gov (NCT06398275; 3 May 2024). Results: EA occurred in 12/32 patients (37.5%) in the control group and 0/30 (0%) in the remimazolam group (p < 0.001). Extubation time and operative durations were similar between groups. More patients in the remimazolam group achieved an Aldrete score ≥ 9 at extubation (76.7% vs. 50.0%, p = 0.030). Severe agitation (RASS ≥ 3) requiring rescue sedation occurred in 6/32 control-group patients and in 0/30 patients in the remimazolam group (p = 0.025). Pain scores were low (no VAS > 2). PONV occurred in one patient per group. Clinically relevant postoperative nasal bleeding requiring intervention occurred in 2/32 control-group patients and in 0/30 remimazolam-group patients. No laryngospasm or respiratory complications within 24 h were observed. Conclusions: A single remimazolam bolus given at the end of surgery prevented clinically relevant EA after rhinologic surgery without delaying early recovery. Full article

Extremely preterm infants often require prolonged respiratory support due to lung immaturity and inflammation, placing them at high risk of lung injury and development of bronchopulmonary dysplasia (BPD). In many of these infants, systemic postnatal corticosteroids are used to reduce lung inflammation, facilitate mechanical ventilation (MV) weaning and extubation, and improve short-term pulmonary outcomes. However, despite decades of clinical use, substantial variation persists in timing, choice of agent and dosing. These inconsistencies reflect a lack of strong evidence and a limited understanding of the systemic and organ-specific effects of therapy for a highly heterogenous population usually exposed to this medication. This narrative review addresses these gaps by integrating current knowledge of the inflammatory and respiratory effects of postnatal corticosteroids in extremely preterm infants. We explore how corticosteroids modulate pulmonary inflammation, their effects on lung development, and how they affect key clinical outcomes such as extubation success and BPD severity. We also examine evolving approaches to corticosteroid administration and dosing, highlighting the importance of individualized strategies informed by developmental and disease-specific considerations. Comparative data from randomized controlled trials are reviewed, including the efficacy and side-effect profiles of commonly used regimens. Current evidence supports judicious use of late low-dose dexamethasone, while early prophylaxis with inhaled or intratracheal steroids remains experimental and is not routinely advised. In line with a physiology-driven approach, we also discuss emerging domain-specific monitoring tools that may enhance patient selection and optimize timing of intervention. By synthesizing mechanistic insights with clinical evidence, this review supports a more nuanced, individualized approach to postnatal corticosteroid therapy in extremely preterm infants, balancing therapeutic benefits with potential systemic trade-offs. Full article

Background: Esophagectomy is an invasive treatment for esophageal cancer associated with postoperative complications and mortality. Herein, to prevent postoperative complications, early extubation (EE) in the operating room without overnight mechanical ventilation (MV) was introduced. Methods: We compared overnight MV and EE to evaluate the impact on short-term outcomes post-esophagectomy. In total, 91 patients with thoracic esophageal cancer who underwent subtotal esophagectomy were included. In total, 26 patients were extubated in the operating room postoperatively (EE group), and 65 were extubated the following morning (MV group). Propensity score matching was used to assemble a well-balanced cohort. The clinical and postoperative outcomes were investigated; the postoperative fluid balance in the intensive care unit was compared between groups. Results: Propensity score matching produced 21 paired cases from the cohort; the groups were comparable. The EE group had a lower operative time and fluid-in/out balance in the intensive care unit than the MV group. Regarding postoperative outcomes, the EE group had shorter postoperative hospital and intensive care unit stays. In addition, the EE group had significantly fewer incidences of pulmonary complication and surgical site infection. Conclusions: EE was associated with shorter postoperative hospital and intensive care unit stays and reduced incidence of pulmonary complications and surgical site infections by preventing volume overload in the intensive care unit. Full article

Background: Adequate analgesia is essential for enhanced recovery following major abdominal and thoracic surgery. Intravenous methadone has emerged as an alternative analgesic modality to traditional epidural analgesia. This study compares intravenous methadone with epidural analgesia in postoperative pain. Methods: We retrospectively analyzed adult patients who underwent laparotomy or non-cardiac thoracotomy between January 2019 and December 2022 and who had either general anesthesia with epidural analgesia or intravenous methadone. Co-primary outcomes were mean numeric rating scale (NRS) pain scores and cumulative opioid consumption from extubation until the end of postoperative day 2. Pain scores were obtained regularly from routine postoperative assessments documented in the electronic health record and were not recorded at predefined postoperative hours. Secondary outcomes related to analgesia, recovery, and clinical outcomes were examined. Results: We analyzed 796 adults (mean age 58 ± 15 years, 52% male, 68% ASA III–IV), of which 691 (87%) underwent laparotomy and 105 (13%) underwent non-cardiac thoracotomy. Patients receiving methadone had a higher postoperative NRS score (0.4 points, 95% CI 0.23 to 0.62, p < 0.001), with a mean NRS of 2.1 ± 1.4 points in the methadone group and 1.6 ± 1.2 points in the epidural group. The postoperative opioid consumption (morphine equivalent dose) was lower in the methadone group (23 ± 31 vs. 29 ± 43 mg, −7.2 mg, 95% CI −12.6 to −1.79, p = 0.009). Methadone was associated with earlier mobilization (−0.13 days, 95% CI −0.24 to −0.01, p = 0.030). Epidural patients had greater need for escalation of laxatives (26% vs. 15%, p = 0.016), while time to extubation was shorter (8.4 min, 95% CI 6.2 to 10.5, p < 0.001). No differences were observed in maximum NRS, oxygen demand, blood product transfusions, major adverse cardiac and cerebrovascular events, or length of stay. Conclusions: Methadone was associated with higher, clinically non-relevant postoperative pain scores and a clinically non-relevant reduction of postoperative opioid use. Full article

Objectives: Lung transplantation is a life-saving option for patients with end-stage lung diseases, yet immunosuppression management remains challenging. Induction therapy with interleukin-2 receptor antagonists (IL2-AR), such as basiliximab and daclizumab, is designed to reduce acute rejection and improve graft survival. However, its efficacy compared with alternative agents or no induction therapy remains uncertain. This study aimed to evaluate the impact of IL2-AR induction on clinical outcomes in lung transplant recipients. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Studies comparing IL2-AR induction with antithymocyte globulin (ATG), alemtuzumab, or no induction therapy were included. The primary outcomes were overall survival and freedom from acute rejection. Secondary outcomes included freedom from bronchiolitis obliterans syndrome (BOS), hospital length of stay (LOS), and time until extubation. Kaplan–Meier curves were reconstructed for long-term outcomes. Random effects model was performed. Results: Twelve studies comprising 27,855 patients were included. IL2-AR induction was associated with improved overall survival compared to standard of care (HR 0.88; 95%CI 0.85–0.93; p < 0.01). However, sensitivity analyses, including two-stage meta-analysis and leave-one-out analysis, revealed a loss of statistical significance. No significant differences were found for freedom from acute rejection (p = 0.774) or secondary outcomes, including freedom from BOS (p = 0.455), hospital LOS (p = 0.423), and time until extubation (p = 0.186). Conclusions: IL2-AR therapy may be associated with improved survival after lung transplantation; however, evidence remains inconclusive due to heterogeneity and limitations in study design. Full article

Introduction and Objective: This study aims to evaluate the effect of perioperative factors and radiographic Brixia scores on early extubation following corrective surgery for Fallot tetralogy at a high-volume single cardiac center. Materials and Methods: A retrospective evaluation was conducted on 120 cases who underwent complete correction due to Fallot tetralogy [Median age 6 months (IQR 5–7), Median weight 6.2 kg (IQR 5.2–8 kg)]. Patient demographics, preoperative characteristics, intraoperative variables, postoperative outcomes, surgical type, surgical duration, cardiopulmonary bypass (CPB) time, cross-clamp time, and blood product volumes were retrieved from electronic medical records. P/F ratio, PaO₂/FiO₂, and Oxygen Index (OI) were calculated. Early extubation was defined as extubation occurring within 6 h after the completion of surgery. The Brixia score (Interstitial opacities, 1 point; interstitial predominant alveolar, 2 points; and interstitial and alveolar opacities, 3 points) was graded for both lung lobes divided into three segments, with a total score ranging from 0 to 18. The results were analyzed statistically. Results: In 60% of the cases (n = 72), valve-preserving surgery was performed, and in 40% (n = 48), a transannular patch was used. The early extubation rate was 20% (n = 24). The median duration of mechanical ventilation was 10 h (IQR, 6–15). Older age (median 8 vs. 5 months), valve-preserving surgery, lower incidence of right-to-left shunt Patent Foramen Ovale (63% vs. 84%), higher P/F ratio on ICU admission (360 vs. 220), and lower Brixia scores on ICU admission (8 vs. 11) and on postoperative day 1 (7 vs. 12) were identified as significant factors for early extubation (p < 0.05). The mortality rate in the entire patient group was 3.3%. In multivariable logistic regression analysis, older age (OR: 1.2, 95% CI: 1.1–1.9 p = 0.03), valve-sparing repair (OR: 1.7, 95% CI: 1.2–2.5, p = 0.008), and lower postoperative Brixia scores (OR:1.4 95% CI: 1.2–2.1, p = 0.02) remained independently associated with early extubation. Conclusions: The Brixia score can be used as a reliable scoring system for evaluating postoperative lung status. Pulmonary valve-preserving repair shows a profile of earlier lung parenchyma recovery compared to transannular patch repair. Full article