ABSTRACT
INTRODUCTION: This study reports the development of a new, accurate and reproducible method which combines histological and computer techniques for the determination of fatty load in cholesterol-fed rabbits. METHODS: New Zealand male rabbits were randomly divided into three groups. The animals in group 1 (control) received neither cholesterol nor drugs. Those in group 2 received a 2% cholesterol diet for 30 days, followed by a normal diet for 45 days. In addition during the latter period (day 31 to day 75) animals received 200 g of chopped carrots each morning. The rabbits in group 3 followed the same dietary regime as those in group 2 except that 8.36 mg of simvastatin and 1.76 g cholestyramine were mixed with their carrots. On the 76th day, the animals were sacrificed and their blood and hearts were collected. Histological sections (15 microm thick) of hearts were cut at 90 degrees to the long axis using a motorized freezing microtome. Every tenth section was mounted on a glass slide and stained with Oil Red O. A total of hundred slides prepared from each heart were scanned into a computer and the area stained by Oil Red O was measured, giving a measure of the total fatty "load" in each heart. RESULTS: There was a highly significant increase in the coronary fatty deposits in the hearts of the animals fed with cholesterol rich diet (group 2) as compared to the control rabbits in group 1. Treatment of rabbits with simvastatin plus cholestyramine (group 3) significantly reduced the coronary lipids load. DISCUSSION: The combination of histological and computer-based techniques used in this study provides an accurate and reproducible method for the quantitation of fatty deposits in rabbit coronary vessels. This report is based on the measurement of coronary lipid depositions rather than aortic lesions. It also overcomes the shortcoming of the majority of the earlier published methods which are generally limited to the measurement of fatty plaques in only few major coronary vessels, totally neglecting the many small distributive vessels which are often responsible for cardiac ischemic disease.
Subject(s)
Coronary Vessels/chemistry , Lipids/analysis , Lipids/blood , Software , Analysis of Variance , Animals , Azo Compounds/chemistry , Cholesterol/analysis , Cholesterol/blood , Cholesterol, Dietary/administration & dosage , Cholestyramine Resin/administration & dosage , Cholestyramine Resin/pharmacology , Coronary Vessels/drug effects , Coronary Vessels/pathology , Heart/drug effects , Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage , Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacology , Male , Myocardium/chemistry , Myocardium/pathology , Rabbits , Reproducibility of Results , Simvastatin/administration & dosage , Simvastatin/pharmacology , Staining and Labeling/methods , Time FactorsABSTRACT
STUDY OBJECTIVE: To describe our initial experience of the perioperative anesthetic care provided to pediatric recipients during living-related liver transplantation. DESIGN: Cohort review of the perioperative anesthetic care for living-related liver transplantation. SETTING: Tertiary referral and postgraduate teaching hospital. PATIENTS: 27 children (20 males, 7 females) with end-stage hereditary metabolic liver disease requiring living-related liver transplantation. INTERVENTION: Perioperative care was administered during living-related liver transplantation. MEASUREMENTS: The major intraoperative physiologic events and concerns are described, as well as the anesthesia technique for pediatric living-related liver transplantation anesthesia. Intraoperative changes in physiologic parameters and the intraoperative requirements in our series are also reported. MAIN RESULTS: During a 30-month period, 27 children (20 males and 7 females) were scheduled for transplantation with an hepatic graft from a living-related donor. Twenty-six children received a graft from a living-related donor, and one was retransplanted with a cadaveric graft because of graft failure, and one child received a cadaveric graft because of the lack of a suitable donor. All patients received intravenous (IV) anesthesia with fentanyl, midazolam, and cisatracurium, and were ventilated with oxygen/air. Mean induction and presurgical preparation time was 1.18 hours, with a surgical time of 6.55 hours. All but one patient was extubated on the evening of the operating day after receiving a mean dose of 8.67 microg kg(-1) hr(-1) of fentanyl and a mean dose of 0.124 mg kg(-1) hr(-1) midazolam. The need for crystalloid infusion was 24.0 mL kg(-1) hr(-1), fresh frozen plasma (FFP)16.63 mL kg(-1) hr(-1), and red blood cells 7.98 mL kg(-1) hr(-1). There was no mortality and no anesthetic-related morbidity in our series. CONCLUSIONS: Total IV anesthesia with fentanyl, midazolam, and cisatracurium, after preoperative optimization, is a well-tolerated approach for children undergoing living-related liver transplantation and offers quick recovery. This anesthetic technique was aimed at minimizing the effects on the cardiovascular system, and also any consequences related to the possible occurrence of a reperfusion syndrome. Fluid balance was aimed at optimizing flow through the hepatic graft and preventing thrombosis of vascular anastomoses.
