Methylprednisolone and postoperative pulmonary function following minimally invasive cardiac surgery under ultra-fast-track anesthesia

This study aimed to assess the association between intraoperative methylprednisolone administration and postoperative pulmonary function in patients undergoing minimally invasive cardiac surgery via a right axillary incision under ultra-fast-track anesthesia. Clinical data from 238 patients who underwent minimally invasive cardiac surgery through a right axillary incision under ultra-fast-track anesthesia at Zhejiang Provincial People’s Hospital between January 2022 and July 2023 were retrospectively analyzed. Participants were assigned to either the methylprednisolone group (Group M, n = 119) or the control group (Group C, n = 119) according to whether methylprednisolone was administered after anesthesia induction. Pulmonary function was assessed using the oxygenation index (OI = PaO2/FiO2), respiratory index (RI = PA-aO2/PaO2), and incidence of pulmonary atelectasis and pulmonary edema. Measurements were obtained preoperatively (T0) and at 1 h (T1), 6 h (T2), 12 h (T3), and 24 h (T4) postoperatively. In both groups, OI values from T1 to T4 were significantly lower than those at T0 but demonstrated a gradual postoperative increase. Group M exhibited higher OI values than Group C across all postoperative time points (T1–T4) (p < 0.05). RI values in both groups increased from T1 to T4 compared with T0 but presented a decreasing trend over time; RI values in Group M were significantly lower than those in Group C at all postoperative intervals (p < 0.05). At T2, hypersensitive C-reactive protein levels were significantly lower in Group M than in Group C (p < 0.05). No significant differences were observed between groups in the incidence of pulmonary atelectasis or pulmonary edema (p > 0.05). Intraoperative administration of methylprednisolone at a dose of 1–4 mg/kg following induction of ultra-fast-track anesthesia for minimally invasive cardiac surgery via a right axillary incision was associated with improved gas exchange and oxygenation during the first 24 postoperative hours. These findings indicate a potential protective effect of methylprednisolone on pulmonary function in the early postoperative period following cardiopulmonary bypass.