Propofol

No children were pre-medicated. Children routinely fasted from food for ≥6 h and from drink for ≥4 h before surgery. Peripheral intravenous access was established for all patients in the hospital ward. In the operating room, a continuous monitor (S/5TM monitor; GE Healthcare, Germany) was used for noninvasive blood pressure (NIBP), pulse oxygen saturation (SpO₂), heart rate (HR), and electrocardiogram (ECG) monitoring. After oxygen inhalation via a facemask was initiated, general anesthesia was induced by the continuous intravenous injection of 3 mg/kg of propofol (1% propofol in a medium-chain/long-chain triglyceride emulsion; Fresenius Kabi Deutschland Gmbh, Germany) for over 30 s, followed by an observation period of 4 min. Routine oxygen inhalation via the facemask was continued during propofol administration, and the lower jaw was gently raised as needed to assist airway management and maintain a blood oxygen saturation of ≥97%. At the end of the observation period, 2 mg/kg of propofol (Fresenius Kabi Deutschland Gmbh, Germany), 2 μg/kg of fentanyl (Yichang Humanwell Pharmaceutical Co., Ltd., Hubei Province, China), and 0.5 mg/kg of rocuronium (Hameln Pharmaceuticals Gmbh, Germany) were administered for routine induction. The patient was intubated or received a laryngeal mask after a sufficient depth of anesthesia was achieved.

Propofol was used as standard of care for endotracheal intubation in our units. Propofol (Fresenius Kabi, Schelle, Belgium) was administered as intravenous bolus followed by a saline flush for a total duration of 30 s. After Propofol administration, the pre-intubation sedation level was assessed every 30 s up to 3 min after the infusion, using the Intubation Readiness Score (IRS).22 (link) When the pre-intubation sedation level was adequate, intubation was continued. In the case of insufficient pre-intubation sedation level after 3 min, additional Propofol was administered until the pre-intubation sedation level was sufficient. The amount of each additional Propofol dose was left at the discretion of the attending physician. After intubation, the quality of intubation was measured by the Viby-Mogensen intubation score.23 (link) Data regarding Propofol doses and intubation attempts were reported.

The animals were premedicated with 0.5 mg/kg of diazepam and 5 mg/kg of ketamine hydrochloride intramuscularly, followed by general anesthesia using 1 mg/kg of propofol (Fresenius Kabi, Bad Homburg, Germany) intravenously (i.v.), and maintained with a mix solution of 0.25 mg/kg/h of diazepam, 2.5 mg/kg of ketamine hydrochloride, and 0.0125 mL/kg/h of compound detomidine hydrochloride or 0.5 mg/kg/h of propofol i.v. in turn. The respiration was supported by a ventilator (Dräger, Lübeck, Germany) through an inserted trachea cannula. Five hundred milliliters of 5% glucose and 0.9% sodium chloride and 500 mL of hydroxyethyl starch 130/0.4 and sodium chloride injection (Fresenius Kabi, Bad Homburg, Germany) were also administered i.v.. In addition, 100 mL of 0.3 g of levofloxacin lactate and 2 million units of benzylpenicillin were given i.v. 30 min before surgery. The same anesthetic protocol was used for donor retrieving and transplantation.