James C. Eisenach, M.D., Editor

SOAP 30th Annual Meeting. Vancouver, British Columbia. April 29, 1998.

The 30th annual meeting of SOAP was held beginning April 29, 1998, at the Hyatt Regency Hotel in beautiful Vancouver, British Columbia. More than 540 members were present for the annual scientific meeting of the Society.

This year's meeting, hosted by Dr. Joanne Douglas (Vancouver, BC), boasted an excellent program supported by SOAP members from not only North America, but from around the world. Keeping with its mission of promoting safety in the practice of obstetric anesthesia, the Society sponsored a pre-SOAP Symposium this year, the Management of Critical Events in Obstetric Anesthesia, which featured two full- scale human patient simulators and a difficult airway workshop supported by an expert faculty of SOAP members. In addition to the traditional presentation of selected scientific papers in the traditional oral, poster, and discussion formats, the scientific meeting featured a series of debates dealing with controversies in obstetric anesthesia practice. Two eponymous lectures, the Fred Hehre Lecture and the newly established Gerard W. Ostheimer What's New Obstetric Anesthesia Lecture were featured during the scientific meeting as well as two traditional invitational lectures, What's New In Obstetrics? and What's New in Perinatology? Other meeting highlights included the Gertie Marx Symposium for the best paper by a resident or fellow, a series of breakfast panels on a variety of topics from “The Art of Presentation” to “The Internet,” and a first look at a new patient education video dealing with choices for obstetric analgesia cosponsored by SOAP and the B. Braun Company.

The pre-SOAP Symposium held during the Wednesday registration day featured an airway workshop and crisis simulation sessions for those attending. Under the direction of cohosts Dr. Rita Patel (San Antonio, TX) and Dr. Richard Wissler (Rochester, NY) registrants were rotated between stations working as team leaders and supporting members in simulated obstetric practice emergencies. Each student acting as team leader was videotaped during a simulated emergency scenario and subsequently debriefed by a member of the faculty.

Dr. Joanne Douglas (Vancouver, BC) who warmly welcomed SOAP to her home city opened the scientific meeting on Thursday morning. Dr. Douglas introduced the President of SOAP, Dr. Gerard Bassell (Manhattan, KS), who began by moderating the Gertie Marx Symposium, Dr. Bassell announced that although Dr. Marx, an emeritus member of SOAP, could not attend this year's meeting for health reasons her spirit was with us and obviously present in the six excellent resident/fellow papers chosen for presentation.

Dr. A. Levin (Brigham and Women's Hospital, Boston, MA) presented “Intrathecal Ropivacaine Plus Sufentanil Compared with Intrathecal Bupivacaine for Labor Analgesia,” concluding bupivacaine and ropivacaine offered equivalent analgesia and motor block when administered intrathecally.

Dr. E. G. Grubbs (Duke University Medical Center, Durham, NC) presented “Nitric Oxide Synthase Activity in Fetal Guinea Pig Brain following Hypoxia and Magnesium Sulfate Exposure,” suggesting that magnesium sulfate may further augment the physiologic insult induced by cerebral hypoxia in the fetus.

Dr. J. Phillip (University of Texas Southwestern, Dallas, TX) presented “Transient Radicular Irritation: A Comparison of 5% Lidocaine vs. 0.75% Bupivacaine for Spinal Anesthesia,” showing a similar incidence of transient radicular irritation in patients receiving 5% spinal lidocaine (3% incidence) or bupivacaine (7% incidence) when controlled for patient position and type of surgery. All episodes resolved within 48 h of onset.

Dr. S. Y. Wang (Brigham and Women's Hospital, Boston, MA) presented “Pregnancy Alters Adrenergic Mechanisms in the Uterine Microcirculation of Rats,” which explored neurohumoral regulation of uterine microcirculation.

Dr. G. Meister (Wake Forest University, Winston-Salem, NC) presented “Ropivacaine/Fentanyl Provides Equivalent Epidural Analgesia with Less Motor Block than Bupivacaine/Fentanyl,” which proposed an advantage for ropivacaine in labor analgesia.

Dr. J. Y. Yeh (Stanford University, Stanford, CA) presented “Walking Epidurals: Impact of Bupivacaine Bolus Concentration and a Lidocaine-Epinephrine Test Dose,” which suggested that an epidural test dose with epinephrine is best avoided if patients desire to ambulate with epidural analgesia.

The Gertie Marx prizes were awarded at the SOAP Banquet. Dr. Levin received the first place prize, Dr. Phillip the second place prize, and Dr. Meister the third place prize. All participants were congratulated on their excellent work.

After the Symposium and a break to review poster presentations, Dr. Shoo Lee (University of Vancouver, Vancouver, BC) presented the “What's New in Meeting Abstracts?” lecture, in which the outlined the need for better understanding and research into the newborn's perception of pain.

After the lecture and the first oral scientific paper presentation moderated by Dr. Alan Santos (Bronx, NY) members assembled for the first debate, “Epidurals with Dilute Solutions are Better than Combined Spinal Epidural Analgesia.” Dr. David Dewan (Chapel Hill, NC) argued the pro, and Dr. Mark Norris (St. Louis, MO) argued the con on this controversial topic.

The first meeting day concluded with two presentation sessions: the first, an oral presentation session moderated by Dr. David Chestnut (Birmingham, AL), and the second, a poster review moderated by Dr. Valerie Arkoosh (Philadelphia, PA).

The Annual Business Meeting followed. Of note, SOAP members elected Dr. Valerie Arkoosh as Second Vice-President and Dr. Donald Penning (Durham, NC) to fill Dr. Arkoosh's remaining term as Secretary. The three SOAP Traveling Scholars were introduced by their hosts, Dr. Victor Morales (Santiago, Chile) hosted by Dr. G. Bassell (Wichita, KS), Dr. Patrick Olang (Nakuru, Kenya) hosted by Dr. Mark Norris (St. Louis, MO), and Dr. Nuntiya Techakittiroj (Bangkok, Thailand) hosted by Dr. Cliff Chadwick (Seattle, WA). The business meeting concluded with the selection of Hilton Head, South Carolina for SOAP 2001.

Friday began with the second debate, “All Patients Having General Anesthesia at Greater than 12 Weeks Gestation Need to be Intubated.” Dr. Joy Hawkins (University of Colorado, Denver, CO) argued the pro position facing Dr. Chris Rout (University of Natal, Kwazula-Natal, South Africa), who argued the con. Despite clear and concise arguments presented by the worthy opponents, the issue remained unresolved in the minds of many who nevertheless left the debate better informed.

Dr. Thomas Benedetti (University of Seattle, Seattle, WA) delivered the second invitational lecture, “What's New in Obstetrics?” to a full house of participants. Dr. Benedetti's talk concentrated on new advances in the treatment of troubling obstetric conditions.

After an informative set of oral presentations moderated by Dr. Sheila Cohen (Stanford, CA), Dr. Gershon Levinson (San Francisco, CA) presented the eponymous Fred Hehre Lecture. Dr. Levinson discussed his career as an obstetric anesthesiologist relating the many controversies he had seen and his work with Dr. Sol Schneider in responding to the many issues facing obstetric anesthesiology over the years.

The Fred Hehre Lecture was followed by a poster presentation review moderated by Dr. William Camann (Boston, MA) and an open forum discussion of the proposed ASA Obstetric Anesthesia Practice Parameters led by Dr. Joy Hawkins (Denver, CO).

Saturday began with a series of Breakfast Panels. Dr. David Birnbach and other SOAP faculty featured a problem-based learning seminar titled, “Breakfast with the Experts.” Dr. Stephen Gatt (Sydney, Australia) and others hosted a workshop titled, “The Art of Presentation: How to Prepare and Present a Lecture.” Dr. Patricia Dailey (Hillborough, CA) and others led the workshop titled, “Obstetric Anesthesia in a Private Care Setting-Different Practice Styles.” Dr. Gerald Burger and others (Cleveland, OH) led the Internet workshop.

After breakfast, the newly initiated Zuspan Award for best obstetric paper was presented by Dr. Celine Traynor (Dublin, Ireland) to Dr. Andrew Shennan (London, UK) for his study, “The Maternal Haemodynamic Response to Low Dose Spinal and Epidural Anaesthesia in Pre-Eclampsia.” Dr. Andrew Shennan's study demonstrated a greater decrease in systolic blood pressure in preeclamptic women receiving spinal analgesia for labor (bupivacaine, 2.5 mg) versus those receiving epidural analgesia (bupivacaine, 10 mg) or in control subjects without preeclampsia.

Dr. David Campbell (University of Saskatchewan, Saskatoon, Canada) delivered the first Gerard W. Ostheimer What's New in Obstetric Anesthesia? Lecture. This eponymous memorial lecture is named for Dr. Gerard Ostheimer, a scholar, teacher, and unparalleled obstetric anesthesiologist lost to SOAP three years ago. In his lecture Dr. Campbell reviewed the year's obstetric anesthesia literature concentrating on controversial issues.

After the Gerard W. Ostheimer Memorial Lecture Dr. Michael Finster (New York, NY) moderated the paper presentations for the Best Presentation of the Meeting. Judges included Dr. Finster, Dr. Sheila Cohen, Dr. Gerard Bassell, and Dr. Fred Zuspan. Papers presented included “Effect of Maternal Catecholamines on the Gravid Uterine Musculature” by Dr. Scott Segal (Brigham and Womens Hospital, Boston, MA) et al., “Continuous Intrathecal Labor Analgesia: Safety and Efficacy” by Dr. Valerie Arkoosh (Allegheny University, Philadelphia, PA) et al., and “Different Epidural Local Anesthetics May Affect the Success Rate of Prophylactic Epidural Blood Patch” by Dr. P. H. Pan (Medical College of Virginia, Richmond, VA). The judges chose Dr. Segal's paper as the “Best of Meeting.”

The final event of the 30th Annual Meeting was a debate:“Spinal Anesthesia Can Be Safely Used in Severely Pre-Eclamptic Patients.” Dr. David Hood (Winston-Salem, NC) argued the pro position, and Dr. Paul Howell (London, UK) argued the con position. Both scholars argued fiercely for their position, but despite their best efforts the issue remained undecided.

In the closing ceremonies Dr. David Birnbach thanked Dr. Douglas on SOAP's behalf for a wonderful meeting inviting members to mark their calendars for the 31st Annual Meeting of SOAP in Denver, Colorado, May 19-22, 1999.

Gerald A. Burger, M.D.

Chair, SOAP Publications Committee; The Cleveland Clinic Foundation; Cleveland, Ohio

(Accepted for publication September 18, 1998.)