Precision TOF-Guided Sugammadex Versus Spontaneous Recovery for Early Extubation in Minimally Invasive Pediatric Cardiac Surgery

Inclusion Criteria: * Age older than 2 years and up to 18 years at the time of surgery. * Scheduled for elective minimally invasive cardiac surgery (MICS) via a right mid-axillary thoracotomy for the repair of simple congenital heart defects (e.g., Ventricular Septal Defect, Atrial Septal Defect). * Surgery requiring the use of cardiopulmonary bypass (CPB). * Deemed an appropriate clinical candidate for the institutional early-extubation (fast-track) pathway. * Intraoperative neuromuscular blockade maintained using rocuronium. * Continuous intraoperative quantitative train-of-four (TOF) monitoring applied and calibrated. * Written informed consent provided by a parent or legal guardian Exclusion Criteria: * Patients arriving at the operating room already intubated or requiring preoperative mechanical ventilation. * Documented history of preexisting neuromuscular disorders (e.g., myasthenia gravis, muscular dystrophy) that alter the pharmacodynamics of neuromuscular blocking agents. * Known hypersensitivity or severe allergic reaction to sugammadex, rocuronium, or any of their excipients. * Severe preoperative hepatic dysfunction or renal impairment (e.g., estimated Glomerular Filtration Rate \< \[30\] mL/min/1.73m²), which alters the clearance of sugammadex or muscle relaxants. * Intraoperative surgical complications requiring conversion from a right mid-axillary thoracotomy to an open median sternotomy. * Intraoperative events mandating delayed extubation for patient safety (e.g., severe hemodynamic instability, massive hemorrhage, or refractory arrhythmias). * Inability to establish or maintain reliable quantitative TOF monitoring data during the procedure.