Stephen Slogoff

Bio: Stephen Slogoff is an academic researcher from The Texas Heart Institute. The author has contributed to research in topics: Cardiopulmonary bypass & Propofol. The author has an hindex of 19, co-authored 24 publications receiving 2518 citations. Previous affiliations of Stephen Slogoff include University of Texas System.

Does perioperative myocardial ischemia lead to postoperative myocardial infarction

Abstract: To determine if a relationship exists between perioperative myocardial ischemia (ST segment depression greater than or equal to 0.1 mV) and postoperative myocardial infarction (PMI), nonparticipating observers recorded all ECG, hemodynamic, and other events between arrival of patients in the operating room and onset of cardiopulmonary bypass during 1,023 elective coronary artery bypass operations (CABG). The roles of preoperative patient characteristics, quality of the operation limited by disease as rated by the surgeon and duration of ischemic cardiac arrest as risk factors for PMI also were quantified. ECG ischemia occurred in 36.9% of all patients, with almost half the episodes occurring before induction of anesthesia. PMI was almost three times as frequent in patients with ischemia (6.9% vs. 2.5%) and was independent of when ischemia occurred. Ischemia was related significantly to tachycardia but not hypertension nor hypotension and was frequent in the absence of any hemodynamic abnormalities. The anesthesiologist whose patients had the highest rate of tachycardia and ischemia had the highest rate of PMI. Although neither single nor multiple preoperative patient characteristics related to PMI, suboptimal quality of operation and prolonged ischemic cardiac arrest increased the likelihood of PMI independent of the occurrence of myocardial ischemia. The authors conclude that perioperative myocardial ischemia is common in patients undergoing CABG, occurs randomly as well as in response to hemodynamic abnormalities, and is one of three independent risk factors the authors identified as related to PMI. PMI is unrelated to preoperative patient characteristics such as ejection fraction and left main coronary artery disease, and its frequency will relate primarily to perioperative management rather than patient selection.

Neuropsychiatric Complications after Cardiopulmonary Bypass: Cerebral Protection by a Barbiturate

Abstract: The authors prospectively investigated the ability of thiopental to decrease neuropsychiatric complications as a consequence of openventricle operations requiring cardiopulmonary bypass. Eighty-nine randomly assigned patients received sufficient thiopental to maintain electroencephalographic silence

On the Safety of Radial Artery Cannulation

Abstract: The frequency of complications following radial artery cannulation for monitoring purposes was determined in 1,699 cardiovascular surgical patients and in 83 patients in whom cannulation was performed in another artery after failure at the radial site. Patients were examined and radial artery flow d

Etiologic factors in neuropsychiatric complications associated with cardiopulmonary bypass

Abstract: A prospective study of 204 patients undergoing operations requiring cardiopulmonary bypass was undertaken to determine the incidence and etiologic factors leading to postperfusion cerebral dysfunction and to determine whether pretreatment with thiopental, 15 mg/kg, would reduce the incidence. Patients were randomly assigned to a control (diazepam) or study (thiopental) group and were treated identically except for the drug administered. Patients were examined neurologically on the 1st and 4th postoperative day and a psychometric test was administered on the 4th day. Although fewer neuropsychiatric complications were present in patients given thiopental, the difference was not significant. The overall incidence of cerebral dysfunction attributable to cardiopulmonary bypass alone was 16.2% for transient and 6.4% for persistent dysfunction (present at the 10th postoperative day). The incidence of postoperative cerebral dysfunction was more than twice as high in patients undergoing intracardiac than in patients having extracardiac operations and more than 4 times as high in patients more than 60 years of age than in younger patients. Perfusion pressure less than 50 torr with hematocrit less than 30% was not related to development of postoperative cerebral dysfunction. The data suggest that air or particulate emboli originating within the heart or aorta are the major causes of postbypass cerebral dysfunction.

Further Observations on Perioperative Myocardial Ischemia

Abstract: Incidence elevee d'ischemie en periode de preinduction et incidence elevee d'ischemie peroperatoire non en rapport avec l'hemodynamique

Adverse Cerebral Outcomes after Coronary Bypass Surgery

Abstract: Background Acute changes in cerebral function after elective coronary bypass surgery are a difficult clinical problem. We carried out a multicenter study to determine the incidence and predictors of — and the use of resources associated with — perioperative adverse neurologic events, including cerebral injury. Methods In a prospective study, we evaluated 2108 patients from 24 U.S. institutions for two general categories of neurologic outcome: type I (focal injury, or stupor or coma at discharge) and type II (deterioration in intellectual function, memory deficit, or seizures). Results Adverse cerebral outcomes occurred in 129 patients (6.1 percent). A total of 3.1 percent had type I neurologic outcomes (8 died of cerebral injury, 55 had nonfatal strokes, 2 had transient ischemic attacks, and 1 had stupor), and 3.0 percent had type II outcomes (55 had deterioration of intellectual function and 8 had seizures). Patients with adverse cerebral outcomes had higher in-hospital mortality (21 percent of patients ...

Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group.

Abstract: Background Perioperative myocardial ischemia is the single most important potentially reversible risk factor for mortality and cardiovascular complications after noncardiac surgery. Although more than 1 million patients have such complications annually, there is no effective preventive therapy. Methods We performed a randomized, double-blind, placebo-controlled trial to compare the effect of atenolol with that of a placebo on overall survival and cardiovascular morbidity in patients with or at risk for coronary artery disease who were undergoing noncardiac surgery. Atenolol was given intravenously before and immediately after surgery and orally thereafter for the duration of hospitalization. Patients were followed over the subsequent two years. Results A total of 200 patients were enrolled. Ninety-nine were assigned to the atenolol group, and 101 to the placebo group. One hundred ninety-four patients survived to be discharged from the hospital, and 192 of these were followed for two years. Overall mortali...