Society for Obstetric Anesthesia and Perinatology 39th Annual Meeting. Banff, Alberta, Canada. May 16–19, 2007.
The 39th Annual Meeting of the Society for Obstetric Anesthesia and Perinatology (SOAP) was held May 16–19, 2007, at the Fairmont Banff Springs Hotel in Banff, Alberta, Canada. An all-time record high attendance of more than 600 registrants enjoyed beautiful mountain scenery, terrific social events, and a fabulous scientific program. During this meeting, there were award presentations for the Gertie Marx, Fred Zuspan, and Best Paper symposia, a pro–con debate, the Fred Hehre lecture, oral and post abstract presentations, and other events.
A preconference day on Wednesday, May 16, featured a simulation workshop, neonatal resuscitation certification sessions, and a well-attended and lively joint symposium between SOAP and the Japanese Society of Anesthesiology. This SOAP–Japan Society of Anesthesiology symposium was designed as a forum for collaboration and discussion of issues related to obstetric anesthesia in Japan. Nearly 100 attendees heard several research presentations and panel discussions on the “crisis” in Japanese prenatal medicine. Japan is currently undergoing a shortage of obstetricians, increasing medical liability exposure, and a decline in available sites for maternity care. Fortunately, an active and dedicated group of anesthesiologists and obstetricians is working hard to ensure that safe care remains available for Japanese childbirth.
On Thursday, May 17, the meeting was opened by President David Wlody, M.D. (Professor of Clinical Affairs, Department of Anesthesiology, Long Island College Hospital, Brooklyn, New York), meeting host Raouf Wahba, M.B. Ch.B., F.R.C.P.C. (Assistant Professor, Department of Anesthesiology, University of Calgary, Calgary, Alberta, Canada), and Scientific Program Chair Gurinder M. S. Vasdev, M.D., F.R.C.A. (Assistant Professor of Anesthesiology, Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota). The first event was the Gertie Marx symposium, an annual session restricted to abstracts presented by trainees. Seven high-quality presentations were heard, and the winner, chosen by a panel of judges, was “Warming with Epidurals Is an Averaging Effect,” presented by Tiffany Gelfand, D.O. (Fellow, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts). Coauthors with Dr. Gelfand were Arvind Palanisamy, M.D. (Fellow), Lawrence Tsen, M.D. (Associate Professor of Anesthesia), and Scott Segal, M.D. (Associate Professor of Anesthesia). Second place was awarded to Weronika Zielinska, B.S. (Medical Student, Mayo Clinic College of Medicine), Eduardo Chini, M.D., Ph.D. (Associate Professor of Anesthesiology, Mayo Clinic College of Medicine), and Gurinder M. S. Vasdev, M.D., F.R.C.A. (Assistant Professor of Anesthesiology, Department of Anesthesiology, Mayo Clinic College of Medicine), for “The Role of the CD38/CADPR Signaling Pathway in Oxytocin in Oxytocin-induced Contraction in Human Myometrium.” Third place was awarded to Damian Horstman, M.D., Ph.D. (Clinical Instructor, Department of Anesthesia, Stanford University, Stanford, California), Edward T. Riley, M.D. (Associate Professor, Stanford School of Medicine), Sachin Mehta, M.D. (Fellow in Obstetrical Anesthesia, Stanford School of Medicine), and Brendan Carvalho, M.D. (Assistant Professor of Anesthesia, Department of Anesthesiology, Stanford University Hospital), for “Cerebrospinal Fluid Pressure and Sensory Block Height with Single-shot Spinal Compared to Combined-Spinal Epidural Anesthesia for Cesarean Section.”
The Distinguished Service Award was presented by President Wlody to Frank James, M.D. (Professor of Anesthesiology, Wake Forest University/Baptist Medical Center, Winston-Salem, North Carolina), for his long and significant contributions to the speciality of obstetric anesthesia and to SOAP.
A pro–con debate was held on the topic of seated versus lateral positioning for epidural placement in labor. This highly spirited and entertaining “Rumble in the Rockies” was debated between Lawrence Tsen, M.D. (Associate Professor of Anesthesia, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts), and Linda Polley, M.D. (Clinical Associate Professor, Department of Anesthesiology, University of Michigan Women's Hospital, Ann Arbor, Michigan). This interactive and multimedia debate presented thoughtful arguments both for and against each position.
The annual “What's New in Obstetrics” lecture was delivered by Michael Helewa, M.D. (Professor of Obstetrics and Gynecology, University of Manitoba, Winnipeg, Manitoba, Canada), immediate Past-President of the Society of Obstetricians and Gynecologists of Canada. This lecture theme was the “Changing Face of Obstetrics” and discussed trends in maternal age, national birth rates, stillbirth rates, obesity, maternal mortality, and the problem of cesarean delivery “on demand,” as well as opportunities and challenges presented by new technologic advances, such as prenatal screening options, genetic counseling, preterm birth prediction, and new techniques for the management of obstetric hemorrhage.
The day concluded with the annual Zuspan research symposium, named in honor of the eminent obstetrician and long-time SOAP advocate, Fred Zuspan, M.D., and was restricted to abstracts done collaboratively by both obstetric and anesthetic colleagues. The winning abstract was “Apoptosis in the Chorion of Fetal Membranes in Preterm Premature Rupture of Membranes” presented by Ronald B. George, M.D., F.R.C.P.C. (Assistant Professor, Women's and Obstetric Anesthesia, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada).
The evening session on Thursday was a new venue for SOAP, a symposium dedicated to research presentation solely by residents. An enthusiastic turnout of nearly 100 presenters and audience members heard a variety of presentations by our future leaders. This session was introduced with the vision and wisdom of our President-Elect, Gurinder M. S. Vasdev, M.D., F.R.C.A., a staunch resident advocate.
Friday, May 18, featured the annual “What's New in Obstetric Medicine” lecture, delivered this year by Linda Barbour, M.D., Past-President of the Society of Obstetric Medicine, and Associate Professor of Obstetrics and Gynecology, University of Colorado, Denver. This fascinating presentation discussed new evidence regarding the etiology and long-term maternal and fetal implications of diseases during pregnancy, particularly preeclampsia and diabetes.
The day concluded with a comprehensive session on patient safety, chaired by Steven Pratt, M.D. (Instructor in Anesthesia, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts), which included a lecture on the role of simulation in obstetric anesthesia, a pro–con debate on the “Crew Resource Management in Medicine Is a Fad” by Richard Wissler, M.D. (Associate Professor of Anesthesiology and Obstetrics & Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York), versus John Pawloski, M.D. (Assistant Professor in Anesthesiology, Beth Israel Deaconess Medical Center), and a lecture and panel discussion led by Edward Molina-Lamas, M.D. (Obstetric Anesthesiologist and now Joint Commission Surveyor) on Joint Commission and National Patient Safety Goals. This lively session allowed the audience to interact with a real-life surveyor and gave many new perspectives on this organization.
The afternoon session on May 18 featured a regional anesthesia workshop led by Jose C. A. Carvalho, M.D., Ph.D., F.A.N.Z.C.A., F.R.C.P.C. (Associate Professor, Departments of Anesthesia and Obstetric and Gynecology, University of Toronto, Toronto, Ontario, Canada; Director, Obstetric Anesthesia, Mount Sinai Hospital, New York, New York), highlighting new techniques, particularly ultrasound, for use in the practice of regional anesthesia.
Saturday, May 19, began with a breakfast panel on “Genomics in Obstetric Anesthesia.” Panelists Richard Hartman, M.D. (Instructor in Anesthesiology, Mayo Clinic College of Medicine), and Ruth Landau, M.D. (Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, Geneva, Switzerland), discussed this intriguing topic. Next was a session on “The Unanswered Questions in Obstetric Anesthesia.” Panelists Robert D'Angelo, M.D. (Professor, Section Head, Vice Chair of Obstetric Anesthesiology, Wake Forest University School of Medicine/Baptist Medical Center, Winston-Salem, North Carolina), Philip Hess, M.D. (Assistant Professor of Anesthesia, Harvard Medical School, Beth Israel Deaconess Medical Center), Barbara Leighton, M.D. (Professor of Anesthesiology, Johns Hopkins University, Baltimore, Maryland), Scott Segal, M.D. (Associate Professor of Anesthesia, Harvard Medical School), and Richard Smiley, M.D., Ph.D. (Professor of Clinical Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York). A wide-ranging array of topics were discussed, including a national registry of complications in obstetric anesthesia, how to assess the safety of new drugs, and implications of maternal fever during labor.
The annual Fred Hehre lecture was delivered by David Birnbach, M.D., M.P.H. (Professor and Executive Vice Chair, Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida). This superb lecture was devoted to the importance of communication skills for enhancing the safe practice of obstetric anesthesia. At the close of the lecture, Dr. Birnbach was awarded a standing ovation for his long and significant contributions to SOAP and the specialty of obstetric anesthesia, and was congratulated on his new position as Vice Provost and Professor at the University of Miami.
The annual “Gerard Ostheimer What's New in Obstetric Anesthesiology” lecture was presented by Alison Macarthur, M.D. (Associate Professor of Anesthesia, University of Toronto). This was a spectacular coverage of the major developments in obstetric anesthesia for the year 2006. The afternoon began with the “Best Paper” session, chaired by Gordon Lyons, M.B.Ch.B., F.R.C.A. (St. James University Hospital, Leeds, United Kingdom; current President of the Obstetric Anesthetists Association). Five superb abstracts were presented. The winner was “Chronic Pain after Delivery: Is It Different between Vaginal and Operative Delivery?” by Peter Pan, M.S.E.E., M.D. (Professor, Department of Anesthesiology, Section of OB/GYN Anesthesia, Wake Forest University School of Medicine). Poster and case report review sessions were chaired by Moeen Panni, M.D. (Associate Professor, Department of Anesthesiology, University of Texas, Houston Medical School, Houston, Texas), and Robert Gaiser, M.D. (Professor of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania), highlighting important and interesting posters submitted to SOAP.
The meeting concluded with a panel discussion on “Infection after Neuraxial Anesthesia.” Therese Horlocker, M.D. (Professor of Anesthesiology, Professor of Orthopedics, Mayo Clinic College of Medicine), discussed the recently promulgated American Society of Regional Anesthesia guidelines, with particular emphasis on the importance of hand washing, and the necessity of wearing a facemask while placing neuraxial anesthetics. She commented on the fact that the package insert for chlorhexidine-alcohol prep solutions states that this agent is not approved for use before lumbar puncture. She explained that this was not due to any particular concerns about neurotoxicity, but rather because the manufacturer did not provide data specifically addressing this issue. A similar situation, in fact, exists with povidone-iodine, with data regarding its safety for lumbar puncture never having been provided; however, because of its long use as a skin prep in this setting, approval of its use was grandfathered. Because both agents exist in the same category of regulatory approval, and because of the increased bactericidal activity of chlorhexidine, particularly with respect to skin organisms such a staphylococcus aureus, Dr. Horlocker suggested that chlorhexidine-alcohol should be considered the prep agent of choice.
Ruth Landau, M.D., next discussed the relative effectiveness of povidone-iodine and chlorhexidine-alcohol. There is little evidence regarding these agents when used for neuraxial anesthesia, but the evidence from the critical care literature overwhelmingly supports a decreased incidence of line infections when chlorhexidine-alcohol is used. Dr. Landau also described a long-term European study of neuraxial infections after regional anesthesia, in which the incidence of neuraxial infection decreased, and subsequently increased, after the initiation and then cessation of the use of chlorhexidine-alcohol.
A lively audience discussion ensued, in which several suggestions that go beyond the American Society of Regional Anesthesia guidelines were made. For example, there was significant audience support for limiting the number of family members and other observers present in the room during placement of regional analgesia, as well as requiring all those present in the room to wear a mask. It was also suggested that the “no-touch” technique, in which the business end of the needle is not handled by the operator, be routinely used.
This superb meeting was held in a spectacular scenic location, and the membership of SOAP was treated to an outstanding program. The next annual meeting of SOAP will be in Chicago, April 30 through May 4, 2008. Please join us!
Immediate Past-President, Society for Obstetric Anesthesia and Perinatology; Brigham and Women's Hospital, Boston, Massachusetts. wcamann@partners.org
