Systemic inflammatory response syndrome (SIRS) often occurs after major surgery. We examine the dynamics of her SIRS in an AAA patient and assess the impact of the number of her SIRS criteria on treatment outcome. SIRS scores and organ failure scores were prospectively recorded daily for all patients. The majority of patients developed SIRS postoperatively. The diagnosis of SIRS and its impact on the postoperative course are well documented in children undergoing cardiac surgery and emergency bowel surgery. A combination of significant fluid replacement, blood transfusion, and surgical tissue trauma puts a patient undergoing major surgery at an increased risk of developing her SIRS during the postoperative period. An increasing incidence of SIRS diagnoses was found in the population with spinal neuromuscular synostosis admitted to the pediatric intensive care unit (PICU). The aim of this study was to investigate the effects of preoperative patient factors and intraoperative anesthesia management on the incidence of postoperative SIRS. Our aim was to retrospectively examine the effects of fluid management, blood transfusion practices, and the decision to extubate on his development of SIRS and length of stay in the PICU. Postoperative data included diagnosis of SIRS in the intensive care unit (ICU), percentage of patients receiving crystalloids in the first 24 and 48 hours, percentage of patients receiving blood products in the first 48 hours, Use of vasopressors in the first 48 hours, days of intubation, length of stay in intensive care unit, length of hospital stay, and frequency of wound infections. Continuous variables were expressed as mean±s.d. and categorical variables were the percentage of results within groups. A univariate analysis was performed to compare the differences in preoperative, intraoperative and postoperative variables between the SIRS and non-SIRS groups. To assess statistical significance between two groups, t-tests were performed for continuous variables and chi-square randomness for categorical variables. Continuous variables with broad distributions were log10 transformed to obtain p-values ​​before analysis, but raw means were calculated and displayed in the results. In addition, we performed a logistic regression analysis to identify risk factors that independently contributed to the development of SIRS. Variables associated with SIRS outcome or showing significant differences in univariate analysis were included in the regression model. After reviewing electronic patient files for intraoperative anesthesia and intensive care documentation, a total of 77 patients met the criteria and were included in the study. Patients were divided into two groups based on her incidence of SIRS in the ICU. There were 34 patients in the SIRS group and 43 patients in the non-SIRS group. Improved surgical technique and anesthesia management to minimize blood loss and significantly improved transfusion strategies, such as mimicking whole blood transfusion, have significantly reduced blood loss in PSF. However, despite these improvements, patient extubation at the end of surgery is often determined by local hospital tradition and the judgment of the individual anesthesiologist. The benefit of delayed extubation in the operating room has not been fully evaluated in relation to the development of her SIRS in a child undergoing her PSF for neuromuscular scoliosis. Our analysis found that a significant proportion of patients in her SIRS group were not extubated at the end of surgery compared with the non-SIRS group.