Contents:SOAP Annual Meeting 2010: Welcome to San Antonio

page 3

SOAP 42nd Annual Meeting Information and Program Schedule

page 4

COMMITTEE REPORTSEducation

page 8

Resident Affairspage 8

Bylawspage 9

Hidden Gems at the WLM

page 10

ASA Launches Vital Health Campaign

page 11

Patient Safety: Meningitis Following Neuraxial Labor Analgesia

page 12

Pioneer’s Corner:Jeffrey Selwyn Crawford

page 13

Letters to the Editorpage 14

Codapage 15

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President’s Message: Variations

Continued on page 2

NewsletterSpring 2010

www.soap.org

Lawrence Tsen, M.D.Brigham and Women’s HospitalHarvard Health SystemsPresident, SOAP

“I have called this principle, by which each slight variation, if useful, is preserved, by the term of Natural Selection.”

– Charles Darwin

n aria set against 30 changing backgrounds, JohannSebastian Bach’s “Goldberg Variations” were com-

posed over a period of 15 years (published together in 1741) and are considered “the model” to which all subsequent variations have been compared. Written for his pupil Jo-

hann Gottlieb Goldberg, these pieces were supposedly conceived to cure the insomnia of Count Kaiserling, the Ambassador from the Imperial Court of Russia to the Electoral Court of Saxony.

Far from putting us to sleep, the Variations serve as a provocative observa-tion on life. The aria’s col-orful melody plays an un-usual subservient role to the 32-bar bass line, which Bach changes just enough to be delightfully unique. Of interest, performers infrequently select these seemingly simple compositions due to their requirement for near-virtuoso techniques. The complexity of the pieces is further in-tensified on the modern piano, as the Variations were written for a harpsichord with two “manuals” (e.g., keyboards), and thus require some daunting finger-work and cross-hand maneuvers. As such, the Variations remind us that multiple different, yet enjoyable, paths can evolve during a single journey, that elements not traditionally in the limelight can be the most relevant, and that external simplicity often belies the furrowed complexity that remains hidden beneath.

So, how do these lessons relate to SOAP?

First, there have been tremendous variations in our lives that have resulted in our current status. Although we’re all involved in the practice of obstetric anesthesiology, de-tours, both accidental and intentional, have placed variation into our lives. For many, our

“For many, our selection of medicine as a career, obstetric anesthesia as a specialty, and SOAP as a professional society were seemingly acts of serendipity. Yet on closer examination, these acts were often guided by specific occurrences or by one or two individuals at critical points… Can you do the same for someone else?”

A

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selection of medicine as a career, obstetric anesthesia as a specialty, and SOAP as a professional society were seem-ingly acts of serendipity. Yet on closer examination, these acts were often guided by specific occurrences or by one or two individuals at critical points. What circumstances resulted in some of your decision points? Did someone en-courage your participation in SOAP? Can you do the same for someone else?

Second, embracing subtle variations can lead to diverse, but satisfying, outcomes. In considering this concept, I’d ask whether SOAP has contributed to your professional satisfaction and commend your reading of a classic article on achieving professional fulfillment by Laura Nash and Howard Stevenson. For their article “Success That Lasts,” these two Harvard Business School professors surveyed hundreds of professionals on assumptions regarding suc-cess and concluded that four components were important: Happiness (feelings of pleasure or contentment about your life); achievement (accomplishments that compare favor-ably against similar goals others have strived for); sig-nificance (a sense of making a positive impact on people you care about); and legacy (the establishment of your values/accomplishments to help others find success). The jewel contained within the article was that real satisfaction can only be accom-plished by establishing deliberate limits… cultivating a sense of “just enough.” In regard to SOAP, what’s “enough” for you at this time? For a few, it may be participating at the Board level (there are two available positions: second vice president and secretary) or on a committee. For others, an involved presence at our meetings and sharing lessons learned with colleagues and patients is sufficient. But I’m asking everyone to consider more. SOAP now hosts two an-nual events, the Sol Shnider Obstetric Anesthesia Meeting and our SOAP Annual Meeting; please extend a personal invitation to (and facilitate the attendance of) your part-ners or colleagues with an interest in obstetric anesthesia. Moreover, when you attend, please book a room within the conference hotel… future meeting room space and room rates are allocated by the overall size of the meeting and the historical percentage of attendees who stay at the hotel.

Finally, behind the peaceful image of SOAP and our wonderfully conducted meetings, an excited cacophony of work is taking place. We’ve accomplished so much this year, including a new user-friendly Web site, a new logo, two new committees (Legacy and CME committees), the hosting of the Sol Shnider Meeting, an annual meeting with sessions jointly sponsored with FAER and pre-sympo-sia on the airway and ultrasound, a redesigned newsletter,

enhanced outreach to ACOG, AWHONN, FAER and APSF, the launch of the Gertie Marx Research Award, a new SOAP/Kybele Fellowship, and dramatic progress on our strategic plan to make SOAP more responsive to you and your needs. These accomplishments have been produced by an amazing group of individuals, including our new Executive Director Michele Campbell, the SOAP Board, committee chairs and members, and you, through your e-mails and phone calls – thank you. Special recognition goes to our 2010 Distinguished Service Award recipient Mark Rosen, M.D. for facilitating the transition of the Sol Shnider meeting to SOAP. Michele Campbell and Robert D’Angelo, M.D. (your incoming President!) have been the recipients of almost daily e-mails or phone calls this past year, and I particularly appreciate their patience and guid-ance.

As you consider the variations in your life and within SOAP, I hope you recognize the role professional friend-ships have played in your satisfaction and success. I think many of us view SOAP as a celebration of friendships, a validation of current activities and an inspiration for fu-

ture activities. Simply put, SOAP requires active partic-ipation, but provides a vital source of energy in return. Reflect on this as you listen to Bach’s “Goldberg Varia-tions.” While Glenn Gould’s rendition remains my favor-ite, Keith Jarrett’s version is

softer and perhaps more lyrical, as is Simone Dinnerstein’s recording, which was amazingly accomplished during the later stages of her pregnancy.

Thanks for the gift of this wonderful year as your presi-dent. I’ve had the pleasure of communicating, meeting and learning from you, and attempting to gently encour-age SOAP in a way that will continue to advance the So-ciety and the specialty. Hopefully, some of these changes will prove useful and stand the test of time! As always, I appreciate your comments, suggestions and ideas.

Cheers, Lawrence

References: Stevenson NL. 1. Managing Yourself: Success that Lasts. Harvard Busi-ness Review, February 2004; 102-109.Glenn Gould, Columbia Masterworks, 1955. Keith Jarrett, ECM re-2. cords, 1989. Simone Dinnerstein, Telarc, 2007.

President’s Message

Continued from page 1

“SOAP now hosts two annual events, the Sol Shnider Obstetric Anesthesia Meeting and our SOAP Annual Meeting; please extend a personal invitation to… your partners or colleagues with an interest in obstetric anesthesia.”

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Manuel Vallejo, M.D.University of Pittsburgh School of MedicineHost, 2010 SOAP Annual Meeting

As the meeting host for the 42nd Annual SOAP An-nual Meeting in San Anto-nio on May 12-16, 2010, I would like to invite you to San Antonio and present the many things to see and do there.

“Emerging Technologies in Obstetric Anesthesia” is our theme, as innovative tech-nology-related sessions will be interspersed throughout the conference program. “The Cultures of Texas” is our social theme, so expect to be immersed in the many cultures of Texas during your stay in San Antonio.

We will be at the Grand Hyatt, which is centrally located on the Riverwalk, a major San Antonio attrac-tion with 2.5 miles of paved sidewalk lined with shops and restaurants, where you can surround yourself with Texas culture and cuisine. The Riverwalk connects other San Antonio interest spots such as the Alamo, the Rivercenter Mall, HemisFair Park, and the Tower of the Americas. Other sites include Market Square and LaVillita, which is an historic arts village.

The meeting begins on Wednesday, May 12, with the SOAP Opening Welcome Reception from 6-8 p.m. at the Grand Hyatt. On Saturday, May 15 from 6:15-7:30 a.m., we will host the Wellness 5K Walk/Run in Hemisfair Park, a few blocks from the hotel. The park features cascading waterfalls and fountains, lushly landscaped areas, historic buildings, a children’s playground, and the San Antonio landmark, the Tower of the Americas. The tower’s observa-tion deck provides panoramic views of San Antonio and a multi-sensory 4-D theater ride, “Skies over Texas.” Later that evening from 6-10 p.m., the SOAP 42nd Anniversary Celebratory Dinner and Awards Ceremony will be held at the Institute of Texan Cultures, a museum established by the Texas Legislature in 1965 that delineates the 21 cul-tures of Texas and the impact they have had on the history and development of the state.

Three optional excursion tours round out our planned social activities program. The first, scheduled for Wednes-day, May 12 from 11 a.m. to 4 p.m., will feature a shopping trip to the Prime Outlets in San Marcos. The mall includes premier outlet stores carrying designer apparel, shoes, lug-gage, home fashions and housewares, jewelry and acces-sories, and plenty of eateries.

The second of these extras, on Friday, May 14 from 8-8:45 p.m. is a San Antonio River tour. Here, you can mingle with colleagues and guests while listening to entertaining narratives of the rich history of the San Antonio River. You will receive helpful information to assist you during your visit to the Riverwalk.

The third outing will be the Natural Bridge Caverns sightseeing excursion, held on Saturday, May 15 from 1-5 p.m. We have booked the Discovery Tour, the original and most popular, which introduces visitors to an underground world of natural beauty and amazement. You’ll walk 180

feet below the ground and travel through a half mile of the largest and most spectacular show cavern in Texas, while listening to the knowledgeable tour guide. You’ll be inspired by ancient formations centuries in the making and still growing

today: stalagmites, stalactites, flowstones, chandeliers and soda straws. Take pictures along the way, because this is one walk through time that you will not want to forget.

Please remember to RSVP on the 42nd SOAP Annual Meet-ing registration form for these optional excursion tours.

No visit to San Antonio is complete without a trip to The Alamo. You can revisit the “Battle of the Alamo,” a pivotal point in the Texas Revolution, when Mexican troops held a devastating assault on the Alamo Mission. Best of all, the Alamo has free admission and is located just a few blocks from the hotel.

The San Antonio weather in May will be perfect (average 75° Fahrenheit) and is an easy travel destination from all parts of the country. On behalf of our Program Committee Chair, Robert D’Angelo, M.D., SOAP President Lawrence Tsen, M.D., and SOAP Executive Director Michele Camp-bell, I Iook forward to seeing you in scenic San Antonio. Southern Texan culture is waiting. Come and enjoy!

SOAP Annual Meeting 2010: Welcome to San Antonio

“You can revisit the ‘Battle of the Alamo,’ a pivotal point in the Texas Revolution, when Mexican troops held a devastating assault on the Alamo Mission. Best of all, the Alamo has free admission and is located just a few blocks from the hotel.”

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SOAP 42nd Annual Meeting“Emerging Technologies in Obstetric Anesthesia”May 12-16, 2010Grand Hyatt on the RiverwalkSan Antonio, Texas

Register online at www.soap.orgHotel InformationThe Grand Hyatt San Antonio Hotel is the official headquarters for the SOAP 42nd Annual Meeting.

Grand Hyatt San Antonio Hotel600 East Market Street, San Antonio, Texas 78205Phone Reservations: 888-421-1442 (U.S. and Canada)International Phone Reservations: 1-402-592-6464 (outside U.S. and Canada)Hotel Main Phone: (210) 224-1234Guest Fax: (210) 271-8019www.grandsanantonio.hyatt.comFor online hotel reservations got to https://resweb.passkey.com/go/soap2010 The daily room rate, not including applicable taxes, is $234 for single/double occu-pancy; $259 for triple occupancy, $284 for quadruple occupancy, and $285 for Grand Club occupancy/level. This rate will be offered for arrivals up to three days prior to the meeting and for departure up to three days after the meeting, based on availability.

Reservations must be made by April 23, 2010 to receive the discounted rate. With a dramatic design that exemplifies this unique city, this new hotel on San Antonio Riverwalk is an exciting blend of modernism and the Latin culture. Warm hospitality, bold colors and exceptional touches create a San Antonio luxury hotel that is perfect for every guest, whether traveling for work or vacation. Take advantage of its premier setting – adjacent to the convention center, HemisFair Park and on the Riverwalk – outstanding amenities and unprecedented service levels to make your experience at this luxurious San Antonio Texas Riverwalk hotel extraordinary.

Visit the official tourism site of San Antonio, Texas: www.visitsanantonio.com

Parking Valet overnight parking is $30.00 plus tax

TransportationThe closest airport to the Grand Hyatt San Antonio hotel is San Antonio International Airport, eight miles away. Taxi or SARTRANS official city airport shuttle service can be utilized to get to/from the hotel.

Optional Tours & ExcursionsOPTION #1: Shopping Excursion at the Prime Outlets in San MarcosWednesday, May 12, 201011:00 a.m. – 4:00 p.m. Cost per person is $36, and includes first class transportation to and from the shops and tour guide. Prices and itinerary are subject to change dependent upon 2010 availability and pricing. Minimum: 23 / Maximum: 56Prime Outlet Mall in San Marcos was recently ranked the third best place to shop in the world as seen on ABC’s “The View”, is Texas’ esteemed shopping treasure. Only 45 minutes away from San Antonio, Prime Outlet Mall includes premier outlet stores carrying designer apparel and sportswear, shoes, luggage, home fashions and housewares, jewelry and accessories, and plenty of restaurants and eateries. Designer shops include A/X Armani Exchange, Barneys New York/Outlet, BCBG-MAXAZRIA Factory Store, Betsey Johnson, Calphalon, Chico’s, COACH, Crate & Barrel, DKNY, Dooney & Bourke, Gap Outlet, Giorgio Armani General Store, Gucci, GUESS, J. Crew, Jones New York, kate spade, La Perla, Michael Kors, Restora-tion Hardware, Saks Fifth Avenue OFF 5TH, Sony, Talbots, Tommy Hilfiger, White House/Black Market, Williams-Sonoma Outlet, and many, many more.

OPTION #2: San Antonio River TourFriday, May 14, 20108:00 p.m. – 8:45 p.m. Mingle with fellow colleagues and guests during this narrated historical tour. Cost per person is $15, which includes admission fees, tour guide. Prices and itinerary are subject to change dependent upon 2010 availability and admission costs.Minimum: 31 / Maximum: 80Join us on a private tour with entertaining narratives of the rich history of the San Antonio River and helpful information to assist you during your visit to the River Walk.

Cruises are 35 to 40 minutes long and cover two and a half miles of the beautiful San Antonio River Walk. Attendees will walk across the street from the Grand Hyatt to be picked up by the river barge at Rivercenter Mall.

OPTION #3: Natural Bridge Caverns TourSaturday, May 15, 20101:00 p.m. – 5:00 p.m. Cost is $55/person, which includes first class transportation, tour guide and admis-sion fee. Actual cavern tour lasts about an hour and a half. Prices and itinerary are subject to change dependent upon 2010 availability and pricing. Time will be allotted for Visitors Center to purchase souvenirs, gifts, food and drinks.$55/person; 4 hour tour (payment will be made directly to the tour company).Minimum: 20 / Maximum: 56It’s the original and Natural Bridge Caverns’ most popular tour, the Discovery Tour introduces you to an underground world of natural beauty and amazement. Travel through a half-mile of the largest and most spectacular show cavern in Texas. You’ll walk 180 feet below the ground, while listening to our knowledgeable tour guide. See awe-inspiring, ancient formations centuries in the making and still growing today, such as amazing stalagmites, stalactites, flowstones, chandeliers and soda straws. Take pictures along the way because this is one walk through time that you will never want to forget.

RSVP on the registration form on the Web site www.SOAP.org for these tours. Please note that if minimum numbers for tours are not met by April 23, 2010, the tour may be cancelled and tour registrants will be notified of cancellation.

Please visit the SOAP website www.SOAP.org for more information.

Program Schedule

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Wednesday, May 12, 2010

7:30 a.m. - 4:00 p.m. Registration

8:00 a.m. - 11:30 a.m. Parallel Workshops:

1:00 p.m. - 4:30 p.m. Difficult Airway Workshop (offered in morning and afternoon) Directors: Maya S. Suresh, M.D.; Uma Munnur, M.D.; Ashutosh Wali, M.D.

Ultrasound Workshop: (offered in morning and afternoon) Director: Jose C.A. Carvalho, M.B., Ph.D., FANZCA

11:00 a.m. - 4:00 p.m. Optional Outing ($36 fee) - Shopping Excursion at the Prime Outlets in San Marcos See tour information on registration form

6:00 p.m. - 8:00 p.m. Welcome Reception at Hotel Come enjoy Margaritas and Nachos to the lively sound of a Mariachi Band

Thursday, May 13, 2010

6:30 a.m. - 5:00 p.m. Registration

6:30 a.m. - 7:15 a.m. Breakfast with the Exhibitors and Poster Viewing

7:15 a.m. - 7:30 a.m. Welcome to the 42nd Annual Meeting President : Lawrence C. Tsen, M.D. President-Elect: Robert D’Angelo, M.D. 2010 Meeting Host: Manuel C. Vallejo, Jr., M.D.

7:30 a.m. - 9:00 a.m. Gertie Marx Research Competition Moderator: Gerard M. Bassell, M.D. Judges: Yakov Beilin, M.D.; Robert McKay, M.D.; Linda S. Polley, M.D.; Brenda Bucklin, M.D.; David J. Wlody, M.D.; Richard N. Wissler, M.D., Ph.D.

9:00 a.m. - 9:15 a.m. Distinguished Service Award: Mark A. Rosen, M.D. Presented by Val Arkoosh, M.D. and Judy Johnson

9:15 a.m. - 10:00 a.m. Coffee Break with Exhibitors and Poster Viewing

10:00 a.m. - 10:50 a.m. Pro/Con Debate: Lumbar Ultrasound: Useful Gadget or Time Consuming Gimmick? Moderator: Paul Howell, M.B., Ch.B. Pro: Jose C.A. Carvalho, M.B., Ph.D., FANZCA Con: David R. Gambling, M.D.

10:50 a.m. - 12:00 p.m. Research Panel: Unwrapping the Secrets of Labor Pain Moderator: Scott Segal, M.D.

Is Chronic Pain after Childbirth Rare, & If So, Why do We Care? James C. Eisenach, M.D.

Mixed-Effects Modeling of the Pain and Progress of Labor Pamela Flood, M.D.

The Genetic Determinants of Pain Perception and Analgesia Ruth Landau, M.D.

12:00 p.m. - 1:00 p.m. Buffet Lunch with Exhibitors and Posters

1:00 p.m. - 1:30 p.m. ASA President Address Alex Hannenberg, M.D.

1:30 p.m. - 2:30 p.m. Special Research Lecture: The Role of Mathematical Modeling in Advancing Obstetric Anesthesia Research Steven L. Shafer, M.D.

Difficult Airway WorkshopDirectors: Uma Munnur, M.D.;Maya Suresh, M.D.; Ashutosh Wali, M.D.u Welcome and Overviewu 16 Station Rotation - 2.5-3 hrs (includes coffee break) Stations: Fiberoptic Inubation/ Tracheobronchial Tree Storz Video Laryngoscope GlideScope AirTraq McGrath Scope WuScope AirQ/AirVu King LTD/King LTSD Combitube/EasyTube LMA Classic/Fastrach/ProSeal/ Excel/C-Trach Levitan Scope/Shikani Stylet/ Video Intubation Scope Retrograde Intubation Cricothyroidotomy Mannekin Cricothyroidotomy Pig Trachea Fiberoptic Intubation and Strategies for Exchanging Tracheal Tubes Jet Ventilation

See registration form for cost information

Ultrasound Workshop: Director: Jose C.A. Carvalho, M.B., Ph.D., FANZCAu Welcome and Overviewu Essentials of US Lecture u Physics and image interpretation u Vascular access u Lumbar spine assessmentu IIG, IIH, and TAP blocks u 4-Station Rotation - 2 hrs (includes coffee break) Stations: TAP, Illioinguinal, and Illiohypogastric Blocks Lumbar Spine Vascular Access Needling Techniques. u Wrap-up and Q&A

See registration form for cost information

Welcome Reception at theGrand Hyatt San Antonio Hotel6:00 p.m. - 8:00 p.m.Experience the cultures of Texas through regional cuisine sampling and mariachi entertainment while enjoying the company of colleagues, friends, and guests at the SOAP Opening Welcome Reception. Please RSVP for this complimentary event on the SOAP Registration Form.

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Fellow Welcome Reception:5:00 p.m. - 6:00 p.m. Margaritas, Chips & Salsa Hosts: Val Arkoosh, M.D.; Curtis Baysinger, M.D.;William R. Camann, M.D.; Joanne Douglas, M.D.; James Eisenach, M.D.; Robert R. Gaiser, M.D.; Ashraf Habib, M.D., B.Ch.; McCallum R. Hoyt, M.D., MBA; Bhavani Kodali, M.D.;Kenneth E. Nelson, M.D.; Susan K. Palmer, M.D.; Linda S. Polley, M.D.; Steve Pratt, M.D.; Dr. Ross; Dr. Santos; Barbara M. Scavone, M.D.; Steve Shafer, M.D.; Richard M. Smiley, M.D., Ph.D.; John T. Sullivan, M.D.; Maya S. Suresh, M.D.; Paloma Toledo, M.D.; Lawrence C. Tsen, M.D.; Manuel C. Vallejo, Jr., M.D.; Richard N. Wissler, M.D.; David J. Wlody, M.D.; Cynthia A. Wong, M.D.; Kathy J. Zuspan, M.D.

Resident & Medical Student Forum: Welcome: Paloma Toledo, M.D.Special Lecture: How to Improve the Odds of Getting Your Manuscript Published (While Having Fun) Cynthia A. Wong, M.D. Director: Paloma Toledo, M.D.Judges: Katie Arendt, M.D.; Mrinalini Balki, M.D.; Brenda Bucklin, M.D.; Brendan Carvalho, M.B.,B.Ch.; Shobana Chandrasekhar, M.D.; Roshan Fernando, M.B., Ch.B.; Stephanie R. Goodman, M.D.; Lydia S. Grondin, M.D.; Stephen H. Halpern, M.D., M.Sc.; Phil Hess, M.D.; Latoya Mason, M.D.; Uma Munnur, M.D.; Peter Pan, M.D.; Wendy Teoh, MBBS, FANZCA; Ashley Tonidandel, M.D.; Gary Vasdev, M.D.

SOAP Wellness 5K Walk/Run6:15 a.m.-7:30 a.m.Let’s all take the first step toward our wellness by par-ticipating in the 2nd Annual SOAP Wellness Walk/Run. Attend this fun event for all; everyone who participates will win by exercising and meeting others. The 5K Walk/Run will begin and end in HemisFair Park, which is a few blocks from the hotel. HemisFair Park features cascading waterfalls and fountains, lushly landscaped areas, historic buildings, children’s playground, and the world Famous San Antonio landmark “The Tower of the Americas.”

Register for this free activity on the SOAP Annual Meeting Registration Form.

Thursday (cont.)

2:30 p.m. - 3:15 p.m. Coffee Break with Exhibitors and Poster Viewing

3:15 p.m. - 4:30 p.m. Poster Review #1 Moderator: Katie Arendt, M.D.

4:30 p.m. - 6:30 p.m. SOAP Business Meeting and Elections

Friday May 14, 2010

6:30 a.m. - 5:00 p.m. Registration

6:30 a.m. - 7:30 a.m. Breakfast with the Exhibitors and Poster Viewing

7:30 a.m. - 9:00 a.m. Oral Presentations Session #1 Moderator: Barbara M. Scavone, M.D.

9:00 a.m. -10:00 a.m. Gertie Marx/FAER Education Lecture: Perioperative Technology: Use and Limitations of Non and Minimally Invasive Hemodynamic Monitoring Michael R. Pinsky, M.D.

10:00 a.m. - 10:45 a.m. Coffee Break with Exhibitors and Poster Viewing

10:45 a.m. - 11:45 a.m. What’s New In Obstetrics? George R. Saade, M.D.

11:45 a.m. - 12:45 p.m. Buffet Lunch with Exhibitors and Poster Viewing

12:45 p.m. - 1:45 p.m. Clinical Update 2010 Moderator: Joanne Douglas, M.D.

Serious Complication Repository Robert D’Angelo, M.D.

Phenylephrine Infusions During Cesarean Section Richard M. Smiley, M.D., Ph.D.

Epidural Blood Patch Michael J. Paech, MBBS, FANZCA

1:45 p.m. - 2:45 p.m. Oral Presentations #2 Moderator: Michael Froelich, M.D.

2:45 p.m. - 3:30 p.m. Coffee Break with the Exhibitors and Poster Viewing

3:30 p.m. - 4:45 p.m. Poster Review #2 Moderator: Wendy Teoh, MBBS, FANZCA

5:00 p.m. - 6:00 p.m. Fellow Welcome Reception

5:00 p.m. - 7:30 p.m. Resident & Medical Student Forum

8:00 p.m. - 8:45 p.m. Optional Outing ($15 fee) - San Antonio River Tour See tour information on registration form

Saturday May 15, 2010

6:15 a.m. - 7:30 a.m. SOAP Wellness 5K Walk/Run: HemisFair Park

6:30 a.m. - 12:30 p.m. Registration

7:30 a.m. - 9:00 a.m. Best Paper Presentations Moderator: Holly Muir, M.D. Judges: Michael J. Paech, MBBS, FANZCA; Stephen H. Halpern, M.D.; Barbara Leighton, M.D.; Lawrence C. Tsen, M.D.; James C. Eisenach, M.D.

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Saturday (cont.)

9:00 a.m. - 10:10 a.m. Triple Debate Special - Morbidly Obese and Requiring a C/S: Is Epidural, CSE, or Continuous Spinal Anesthesia Best? Moderator: William R. Camann, M.D.

Pro Epidural Kenneth E. Nelson, M.D.

Pro CSE Roshan Fernando, M.B., Ch.B.

Pro Continuous Spinal David C. Campbell, M.D., M.Sc.

10:10 a.m. - 10:30 a.m. Coffee Break

10:30 a.m. - 11:30 a.m. Gerard W. Ostheimer Lecture-What’s New in Obstetric Anesthesia? Introduction: John T. Sullivan, M.D. Speaker: Jill M. Mhyre, M.D.

11:30 a.m. - 12:30 p.m. Fred Hehre Lecture Introduction: Charlie Gibbs, M.D. Speaker: Susan K. Palmer, M.D.

1:00 p.m. - 5:00 p.m. Optional Outing ($55 fee) - Natural Bridge Cavern Tour See tour information on registration form

6:00 p.m. - 10:00 p.m. SOAP 42nd Anniversary Celebratory Dinner with Awards Ceremony at the Institute of Texan Cultures Center

Sunday, May 16, 2010

7:00 a.m. - 11:30 a.m. Registration

7:00 a.m. - 8:30 a.m. PBLD: Breakfast with the Experts Moderators: Michael Paech, MBBS, FANZCA; Craig Palmer, M.D. Experts: Yaakov Beilin, M.D.; David C. Campbell, M.D. M.Sc.; Robert R. Gaiser, M.D.; Phil Hess, M.D.; Bhavani Kodali, M.D.; Holly Muir, M.D.; Steve Pratt, M.D.; Ed Riley, M.D.; David J. Wlody, M.D.; Ashutosh Wali, M.D.

8:30 a.m. - 10:15 a.m. Pearls and Pitfalls Moderator: Brendan Carvalho, M.B., B.Ch.

An Electronic Obstetric Anesthesia Medical Record: Lessons Learned Lydia S. Grondin, M.D.

Beyond Platelet Counts: TEG 2010 Manuel C. Vallejo, Jr., M.D.

The Role of Intralipid During ACLS Paloma Toledo, M.D.

Remifentanil PCA for Labor Analgesia Mrinalini Balki, M.D.

Obstructive Sleep Apnea and Postoperative Monitoring Options Stephanie R. Goodman, M.D.

10:15 a.m. - 10:35 a.m. Coffee Break

10:35 a.m. - 11:50 a.m. Best Case Reports of the Year: She Had What? Moderator: Peter Pan, M.D.

11:50 a.m. Closing Remarks

SOAP 42nd Anniversary Celebratory Dinner with Awards Ceremony at the Institute of Texan Cultures Center6:00 p.m. - 10:00 p.m.

Register for this activity on the SOAP Annual Meet-ing Registration Form. With the theme of “Cultures of Texas”, the Institute of Texan Cultures is the perfect setting for this evening’s event. We begin with a re-ception featuring hors d’ oeuvres with a regional flair amidst 20 exhibits on Texan cultures, while traveling mariachis entertain. Dinner begins at 7:00 p.m., fol-lowed by dancing with music provided by a DJ. Dress is business casual.

Cost is $100/person.

Awards: Gertie Marx (1st, 2nd, 3rd), Best Paper, Frederick Zuspan

Entertainment: Mariachi Band, DJ, Self-guided Tours of the Culture Center

Frederick Zuspan Award Judges: Kathy J. Zuspan, M.D.; Gerry Bassell, M.D.; Maya S. Suresh, M.D

PBLD: Breakfast with the ExpertsParticipate in the discussion of two case presentations...

1) A parturient presents to Family Medicine with increasing shortness of breath and amenorrhea; exam reveals a 25 weeks EGA pregnancy and a SaO2 on room air of 85%; she is admitted for expectant management.

2) A laboring parturient at term experiences an unexpected seizure; she is resuscitated and started on a magnesium infusion; shortly thereafter she becomes increasingly obtunded and goes into cardiac arrest.

Cost is $75 per person

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Manuel Vallejo, M.D.University of Pittsburgh School of MedicineChair, SOAP Education Committee

The SOAP Education Committee had a very busy and productive year. John Sullivan stepped down as committee chair to become SOAP treasurer, and I be-came Education Committee chair this past spring. Cur-rently, we have 28 SOAP

members on the Education Committee, with three sub-committees: the Awards Subcommittee, chaired by Mark Zakowski, M.D., the Information Subcommittee, chaired by Cathleen Peterson-Layne, M.D., and the Programs Sub-committee, chaired by Deborah Qualey, M.D.

The Awards Subcommittee is charged with selection of the Education in Research Award and Teacher of the Year Award. The Information Subcommittee is principally re-sponsible for contributing new topics to the SOAP news-letter. The Programs Subcommittee provides review, grad-ing and feedback of case reports submitted to our annual meeting.

There are a number of new projects we will undertake this year: First, initiation of “Clinical Guidance Docu-ments” or “How We Do Things” or “Expert Opinions” on topics related to obstetric anesthesia to be available on the SOAP Web site. These topics will not be standards or guide-lines but expert opinions on topics related to obstetric an-esthesia. Second, our committee will consider writing one or two clinical “Case Scenarios” to be published in Anes-thesiology that will be an opportunity for SOAP to increase its visibility. Third, we will collaborate with the Resident Affairs Committee to publish and offer on our Web site a “Residents’ Guide to Learning in Obstetric Anesthesia.” Fourth, we plan to compose a “Top 10 List” of articles and books for medical educators to be placed on our Web site. Last but not least, the SOAP Education Committee will actively participate in the SOAP Annual Meeting, the Sol Snider Meeting and other continuing medical educational activities, with development of syllabus content and ac-creditation.

The SOAP Education Committee is enthusiastic, excited and ready to contribute to the continued success of SOAP.

COMMITTEE REPORTS

Education Committee: Annual Report

Paloma Toledo, M.D.Northwestern University Feinberg School of MedicineChair, SOAP Resident Affairs Committee

The mission of the SOAP Resident Affairs Committee is to:

Encourage resident inter-•est in obstetric anesthe-sia;Encourage SOAP mem-•bership in residency and after graduation;

Inform residents of the purpose of SOAP in promoting •research and education in obstetric anesthesia;Participate in resident education regarding the practice •and current issues of obstetric anesthesia; and Encourage residents to gain experience in organized •medicine, thereby promoting their development as fu-ture leaders.

We have been working hard over the past year to achieve our missions. Our most exciting event of the year, the Resi-dent Research Forum, will occur on Friday, May 14 from 5 p.m. to 7:30 p.m. This year, we will have a reception for the residents prior to starting the research forum. Cynthia Wong, M.D., the obstetric anesthesia section editor for An-esthesia & Analgesia, will give a special lecture for the par-ticipants titled “How to Improve the Odds of Getting Your Manuscript Published (While Having Fun).” Following the lecture, residents will break into their individual rooms and present their research. You do not need to be a presenter to attend the resident presentations! Everyone is welcome to attend and support our residents and medical students as they present their best research and case reports.

In order to achieve our goal of participating in resident education on obstetric anesthesia, we are partnering with the Education Committee to create a “Residents’ Guide to Learning in Obstetric Anesthesia.” This case-based guide will be designed to help residents supplement their obstetric anesthesia knowledge. We hope to have this ready by 2011, so stay tuned to the SOAP Web site for further updates.

Lastly, we are continually working to develop resident leaders in obstetric anesthesiology. Several resident mem-bers of the committee serve as liaisons to other SOAP com-mittees, and we have two elected positions available for

Resident Affairs Committee: Annual Report

Continued on page 10

9

David Wlody, M.D.State University of New York - Downstate Medical CenterChair, SOAP Bylaws Committee

Like many other organi-zations, the operations of SOAP are ultimately gov-erned by its bylaws. As the goals of the Society evolve over time, so too must its bylaws. The function of the Committee is to evaluate bylaws changes proposed

by any member of the Society, to make a recommenda-tion to the Board of Directors as to the suitability of these changes and, if approved by the Board, to present the pro-posal to the membership at the Annual Business meeting. At this year’s meeting, the following changes will be sub-mitted to the membership for approval:

1. Codification of the membership of the Finance Committee. Although the bylaws make mention of a Fi-nance Committee, and indicate that the Executive Commit-tee advises the president on financial matters, they make no mention of the composition of the Finance Committee. The following addition (in BOLD) specifies that the Execu-tive Committee will serve as the Finance Committee.

10.1.1 EXECUTIVE COMMITTEE: Chair: President. Oth-er members: Immediate Past President, President Elect, First Vice President, Secretary, Delegate and Treasurer.

10.1.2 Duties: to advise the President on matters re-quiring urgent attention, planning, finances, budgets, etc. Also serves as the nominating committee and the finance committee. All actions must be reported to the Board of Directors at the next meeting.

2. Establishment of Committee on CME. In 2009, President Lawrence Tsen, M.D. appointed an ad hoc Com-mittee on Continuing Medical Education, whose task is to explore methods of increasing and improving CME oppor-tunities for both our members as well as the wider com-munity of anesthesiologists. In most organizations, ad hoc committees have a limited lifespan, typically one year. As the importance of our Society’s CME activities will continue to grow, the Board of Directors has approved a proposal to make the CME Committee a permanent part of the SOAP organizational structure. The following addition to the By-laws has therefore been proposed:

10.13.1 Committee on Continuing Medical Education (CME) Chair: Appointed to a three-year term, beginning in 2010, by President with approval of the Board of Direc-tors. Members: as appointed; to include Chair of Annual Meeting Program Committee (President-Elect), First Vice President, Chair of the Education Committee, and Chair of the Educational Track Subcommittee on Obstetric Anesthesia of the American Society of Anesthesiologists.

10.13.2 Duties: to coordinate the CME activities of the Society, including the Annual Meeting, the Sol Shnider meeting, and Web-based CME; to consult with the Chair of the Educational Track Subcommittee on Obstetric Anesthesia of the American Society of Anesthesiologists to minimize overlap between the Society’s CME activities and those of the ASA; and to work with the Executive Director to ensure compliance with Accreditation Council for Continuing Medical Education (ACCME) guidelines.

3. Establishment of the Legacy Committee. A Leg-acy Task Force was established to foster the preservation and dissemination of historical materials pertinent to the Society and to the specialty of obstetric anesthesia. A sec-ondary goal was to encourage SOAP members and others to recognize the Society in their charitable requests, taking the lead from Gertie Marx’s generous recognition of SOAP in her will. The following addition to the bylaws will estab-lish this group as a permanent committee:

10.14.1 Legacy Committee Chair: Appointed to a three-year term, beginning in 2010, by President with approval of the Board of Directors. Members: as appointed; to in-clude the Immediate Past President (two-year term); and Chair of Annual Meeting Program Committee (President-Elect).

10.14.2 Duties: To preserve and disseminate historical materials pertinent to the development of SOAP and the specialty of obstetric anesthesiology; to act as a resource for members of the Society who wish to preserve their recollections of the development and growth of SOAP; to work with the Annual Meeting Program Committee to develop educational activities pertinent to the history of SOAP and the development of the specialty of obstetric anesthesiology; and to establish policies to encourage SOAP members and others to recognize SOAP in their charitable bequests.

All SOAP members are encouraged to familiar-ize themselves with SOAP’s Bylaws and contact me at dwlody@aol.com with any questions or suggestions.

Bylaws Committee: Annual Report

COMMITTEE REPORTS

10

Karen Bieterman, MLISLibrarian, Wood Library-Museum of Anesthesiology

“out of olde bokes … cometh all this newe science”– Chaucer (1328-1400)

The staff of the Wood Li-brary-Museum of Anesthe-siology (WLM) is honored to contribute this article for the SOAP newsletter, and we are likewise grateful and

honored to be the repository of the SOAP archives, taking on the task of preserving the Society’s history.

Like a kid in a candy store, a visitor to the WLM’s rare book room is met with delight. Nestled in a corner of the ASA’s headquarters’ building, the WLM’s rare book collec-tion is housed in the K. Garth Huston, Sr., M.D. Rare Book Room. As an invaluable collection and one of the larg-est of pre-20th century publications, it also includes manu-scripts, letters, artifacts, portraits, pictures and works which marked the advent of special contributions to anesthesia. We have over 1,000 items in our collection, including a section devoted to obstetrical anesthesia.

The rare book collection began with WLM founder Paul M. Wood, M.D. As permanent librarian-curator of the ASA, Dr. Wood collected and built a valuable library-museum of anesthesiology. Housed in numerous buildings and storage facilities over the years, the collection continued to grow under the administration of WLM presidents Charles C. Tandy, M.D. and K. Garth Huston, Sr., M.D. A bibliophile, Dr. Tandy continues to oversee the rare book acquisitions as WLM Trustee and co-chair of the WLM Acquisitions Committee. This closed collection may be used through prior arrangement with the Paul M. Wood Librarian.

In November 2008, the WLM began to outsource the digitization of its rare book collection for access and pres-ervation. The items and bound books are scanned using equipment appropriate for rare and fragile material. This digitization is progressing to ensure that the valuable col-lection will be available for all to use far into the future for scholarly and research activity. Approximately 100 items have been digitized thus far. Prior to shipment, our titles are searched in Google Books and Internet Archive. Our first priority is to digitize items that haven’t been digitized by other vendors.

We recently digitized a selection from our obstetrical col-lection, including the following:

William Dewees’ An• Essay on the Means of Lessening Pain, and Facilitating Cases of Difficult Parturition, 1819. In his dissertation, the author presented his 17 years of expe-rience in the relief of obstetric pain, with inclusion of case reports. Dewees advocated the use of bloodletting to relieve obstetric pain. James Young Simpson’s • Anaesthetic Midwifery: Report on its Early History and Progress, 1848. This was Simpson’s general treatise on anesthesia for midwifery in which he compared the relative virtues of ether, chloroform and nitrous oxide.John Snow’s • On the Administration of Chloroform during Parturition, 1853. In this publication, Snow discussed the relative safety of chloroform anesthesia for relief of la-bor pain.Henry Smith Williams’ • Painless Childbirth, 1914. Wil-liams discussed morphine-scopolamine (“Dämmer-schlaf” or “Twilight sleep”) treatment.

We encourage you to view the digitized rare book items on the WLM Web site at http://www.WoodLibrary Museum.org. Additional items and descriptive data will be added in the near future.

“Like a kid in a candy store, a visitor to the WLM’s rare book room is met with delight. Nestled in a corner of the ASA’s headquarters building, the WLM’s rare book collection is housed in the K. Garth Huston, Sr., M.D. Rare Book Room … We recently digitized a selection from our obstetrical collection.”

Hidden Gems at the WLM

Resident Affairs Committee: Annual Report

residents each year. At the annual meeting, we will be holding elections for the president-elect and secre-tary of the Resident Affairs Committee. The respon-sibilities for each of the positions are listed on the Resident Component section of the SOAP Web site at soap.org/resident-component.php.

If you are interested in joining our committee, please e-mail me at p-toledo@md.northwestern.edu.

I look forward to seeing you in San Antonio!

Continued from 8

11

John Dombrowski, M.D.Chair, ASA Committee on Communications

One of the most impor-tant responsibilities of ASA is to advocate on behalf of the specialty and help en-hance the public percep-tion and understanding of the role anesthesiologists play, every day, in caring for patients and saving lives. This sentiment is the

cornerstone of ASA’s Lifeline branding campaign; and Anesthesiologists for Vital Health is the next evolution in the Lifeline campaign.

ASA will launch this new initiative on March 30, 2010. The campaign, Vital Health, is designed to reinforce the fact that anesthesiologists are the keepers of patients’ vi-tal health in their times of need. We are publicizing re-sults from a consumer survey that highlights the fact that the public may know how to behave to be healthy, but they are not in touch with their vital health scores (such as BMI, cholesterol and blood pressure) and what those scores mean for their core health status.

The components of the program are two-fold: First, we will leverage the survey as a platform for the ASA to gener-ate media visibility for the messages. Second, will promote an interactive, customized online utility called “Know Your Vital Health,” which was designed by ASA members to help the public take that first step in living healthier lives. The program employs a sophisticated media and digital strat-egy to help ASA influence public awareness, while simulta-neously positioning our specialty as a critical component of public health.

Vital Health is a term that ASA defines in the public dialogue. It is the campaign’s calling card, our brand. We define Vital Health as how effectively a person maintains a healthy lifestyle and how that impacts wellness and medical outcomes.

Anesthesiologists for Vital Health presents our specialty with a unique opportunity to speak to the public in a way that we never have before and expand our specialty’s in-fluence. Leading a national conversation on vital health is a natural fit for anesthesiologists. After all, we are the physicians who manage patients’ overall health and vital signs when it counts most.

Please e-mail j.gremmels@asahq.org with your ques-tions and comments.

ASA Launches Vital Health Campaign

Message From the Strategic Planning Committee

Although it was a strategic goal to make online pay-ments through the SOAP Web site seamless by 2010, we have unfortunately encountered barriers delay-ing implementation of electronic processing of credit card information. Due to these problems, members who renew or register for meetings online will receive an e-mail indicating that their SOAP renewal/regis-tration information was received, and a follow-up official confirmation will be sent within two weeks. The Board of Directors is working with ASA manage-ment to convert to electronic processing as quickly as possible.

We thank you for your continued support, patience and understanding.

The SOAP Media Committee Is Soliciting Nominations for the SOAP Media Award.

The goal of the award is to acknowledge the contri-bution of a member of the media in furthering pub-lic awareness of the important role obstetric anes-thesiology plays in the care of the parturient. Any SOAP member may submit a candidate for consider-ation. Send your nominations to Mark Zakowski at mark.zakowski@cshs.org.

Seeking Second VP and Secretary

Now accepting nominations for the following elected positions (to be voted into office at the 2010 Annual Meeting): Second Vice President and Secretary.

You can learn more about these positions in the SOAP Bylaws on the Web site www.SOAP.org in the members only section. If you would like to nomi-nate yourself or someone else, please contact Michele Campbell at m.campbell@asahq.org.

12

Paula Craigo, M.D.Mayo Clinic

I attended the Sol Shnid-er conference – an excel-lent clinical update on ob-stetric anesthesia – in San Francisco a few years ago. My most vivid memory is of a single question posed by one of the speakers. When the presenter asked audience members to raise their hands if they did not

routinely wear masks when placing lumbar epidurals, it seemed half of the several hundred anesthesiologists and anesthetists present put their hands in the air.

“Bacterial Meningitis after intrapartum spinal anesthesia – New York and Ohio, 2008-2009” is the lead article for the Morbidity and Mortality Weekly Report dated January 29, 2010.1 The re-port examines meningitis in five women who had received neuraxial labor analgesia from two anesthesiologists. The causative agent in all cases, when determined, was Streptococcus salivarius.

S. salivarius is an oropharyngeal commensal of relative-ly low virulence. The predominant species on the tongues of healthy people, it may have a role in maintaining a safe flora in the oropharynx.2 When this organism is identified in cerebrospinal fluid, it is often dismissed as a contami-nant; however, in a clinical setting consistent with men-ingitis after neuraxial anesthesia, S. salivarius, a viridans strep, is the most likely causative agent.

In May of 2009, two healthy women in active labor were admitted to the same Ohio hospital three hours apart, and each received spinal analgesia from the same on-duty anes-thesiologist. Thirteen and 15 hours after the spinal injection, each developed fever and headache, and about six hours later became unresponsive. One woman recovered; the other, just 24 hours after her spinal injection, was declared dead at the age of 30. Autopsy revealed the cause of death to be suppura-tive meningoencephalitis. Blood and CSF cultures from both patients grew S. salivarius, and pulsed-gel electrophoresis of the two organisms was identical. Cultures swabbed from the anesthesiologist’s oropharynx were negative; however, in the initial flurry after the women fell ill, providers had received antibiotic prophylaxis against meningococcus. S. salivarius fragments were in fact found using polymerase chain reac-tion (PCR) techniques. Interviews with staff revealed that although hospital policy required face masks during spinal procedures, on the day in question, the anesthesiologist had not been wearing a mask.

The New York cases occurred in September 2008, when two laboring women were admitted to the same hospital one hour apart and provided with neuraxial analgesia. Roughly 20 hours later, each woman was diagnosed with bacterial meningitis. Blood and CSF cultures were nega-tive, but PCR techniques revealed S. salivarius in one pa-tient’s CSF. A third parturient (from several months earlier) who had developed S. salivarius meningitis 19 hours after an intrathecal injection was later identified; this third pa-tient had been cared for by the same anesthesiologist who had cared for the other two.

The involved anesthesiologist routinely wore a face mask during these procedures. Investigators noted, how-ever, that the mask may have been improperly worn, and that visitors – not wearing masks – were commonly present in labor rooms during neuraxial procedures. The hospital subsequently required all persons present during regional

anesthesia to wear masks and mandated maximal barrier precautions, includ-ing sterile gowns, for clini-cians performing neuraxial procedures.

In 2006, the American Society of Regional Anes-

thesia and Pain Medicine recommended the use of masks during regional anesthesia procedures. In 2007, following several cases of meningitis after myelography performed without masks, the Healthcare Infection Control Practices Advisory Committee recommended that surgical masks be worn by proceduralists during spinal injections.3 In 2008, the Association of Anesthetists of Great Britain and Ireland recommended maximal barrier precautions (hand hy-giene, sterile gloves and gowns, cap, mask and large sterile drape) during the insertion of central venous catheters and spinal and epidural procedures.4 However, disagreement exists over the appropriateness of extrapolating preven-tive measures for central line infections, which are rela-tively common, to central neuraxial procedures, in which infection is quite uncommon.5 It seems prudent, though, to wear a mask during these procedures and to require all personnel and visitors in attendance to do so also.

References:de Fijter S, DiOrio M, Carmean J, et al. Bacterial meningitis after 1. intrapartum spinal anesthesia – New York and Ohio, 2008-2009. CDC Morbidity and Mortality Weekly Report. 2010; 59:65-69.Rubin L, Sprecher H, Kabaha A, et al. Meningitis following spinal 2. anesthesia: 6 Cases in 5 years. Infection Control and Hospital Epide-miology. 2007; 28:1187-1190.Hsu J, Jensen B, Arduino M, et al. Streptococcal meningitis follow-3. ing myelogram procedures. Infection Control and Hospital Epidemiol-ogy. 2007; 28:614-617.Gemmell L, Birks R, Radford P, et al. Infection control in anaesthe-4. sia. Anaesthesia. 2008; 63:1027-1036.Lambert DH. Gloved and masked - will gowns be next? Let the data 5. (not logic) decide this issue [8]. Anesthesiology. 2007; 106:877-878.

Patient Safety:Meningitis Following Neuraxial Labor Analgesia

“… in a clinical setting consistent with meningitis after neuraxial anesthesia, S. salivarius, a viridans strep, is the most likely causative agent.”

13

Richard B. Clark, M.D.

J. Selwyn Crawford was born in 1922 in Newcastle upon Tyne, U.K. He entered Leeds Medical School in 1941 and graduated in 1947. To his friends he was known as “Jeff,” but to the trainees and his work colleagues he was “Selwyn.” Jeff became a junior anaesthetic registrar in Dewsbury in 1948. Following time spent in the Royal Air Force, he practiced at Leicester Royal Infirmary, Central Middlesex Hospital and in Rhodesia and Norway. In 1956, he left England to become an anesthetic fellow at the Uni-versity of Pittsburgh and then at Columbia Presbyterian hospital in New York. After completing his fellowship in New York, he worked as a staff anesthesiologist at the Uni-versity of Chicago, where he earned an M.D. degree. (At that time in the U.K., only internists earned the M.D. after spe-cialized work.) Jeff loved de-grees and exclaimed, “M.B., Ch.B., R.C.S., F.R.C.O.G., D.A., M.D. (Illinois)!”

Jeff returned to the U.K. in 1960 to take up a posi-tion in obstetric anesthesia in Aberdeen. It was there that he met his future wife, Eve, with whom he had four sons: Callum, Julian, Iaian and Jonathan. In 1967, he was consulted about the pro-vision of anesthetic services for a new maternity hospital on the Queen Elizabeth Campus in Birmingham. He sub-sequently became the only full-time consultant obstetric anesthetist at Birmingham Maternity Hospital (BMH). Un-der his leadership, the reputation of BMH, as well as his own reputation, expanded beyond the borders of the U.K. His efforts at BMH brought his program international at-tention and a reputation for excellence and innovation. Jeff was very proud of his data collecting methods, which at the time utilized punch cards. The volume of deliver-ies at BMH allowed him to collect large amounts of data resulting in the publication of many scientific papers. The last edition of his textbook Principles and Practice of Obstet-ric Anaesthesia was published in 1978.

Jeff was an excellent teacher, preferring informal rather than formal teaching. “Coffee” was a time where train-ees could discuss issues with Jeff and with the visitors who came to the unit to learn obstetric anesthesia. Although these informal sessions were disliked by some, most who attended came away appreciating what they had learned. Jeff’s international reputation meant that these sessions were also a time to learn about practice elsewhere in the world.

Jeff was a founder of the Obstetric Anaesthetists’ Associ-ation (OAA) and its first president. At that time, the cost of joining the OAA was £1. Jeff was a member of SOAP, and many SOAP members counted him as a friend. Obstetric anesthesia lost a true “pioneer” with Jeff’s death in 1988. He was an outstanding figure, a productive researcher, a legend in obstetric anesthesia, and a pioneer in our field.

Thanks to Dr. Griselda Cooper and the OAA for the information for this article.

Pioneer’s Corner:Jeffrey Selwyn Crawford

“‘Coffee’ was a time where trainees could discuss issues with Jeff and with the visitors who came to the unit to learn obstetric anesthesia.”

Jeffrey Selwyn Crawford

SOAP/Gertie Marx Grant Deadline

The application deadline for the new SOAP/Gertie Marx Education and Research Grant is September 1, 2010. Projects will be awarded up to $50,000. See www.soap.org/2010-gertie-marx.pdf for more details.

14

The Newsletter welcomes reader input. Please send letters to the editor to SOAPeditor@gmail.com. Note that space does not permit publication of all submissions. The Newsletter reserves the right to edit any contributions for clarity/length.

Dear Editor:

I read with interest the “Coda” article in the most recent SOAP newsletter (“Presence of Family Members During Placement of Neuraxial Labor Analgesia,” Winter 2009 SOAP Newsletter). As the director of both the academic and community OB units that the Medical College of Wiscon-sin serves, I have found that partner support during epidu-ral placement is a highly controversial issue.

Nursing, hospital administration and a minority of fac-ulty tend to favor partner support. They argue that it is a patient satisfaction issue and that epidural placement is the only procedure on the labor and delivery unit during which partners are not allowed. The rest of my colleagues feel just as strongly that partners should not be present. They feel that new residents might be intimidated and that the partner may become ill. We were unable to resolve the issue with a single policy, except to state that if a partner was allowed to stay, they must remain seated and not par-ticipate in the care of the patient in any way.

I look forward to reading more about this in the future!

Libby Ellinas, M.D.Medical College of Wisoconsin

Dear Editor:

I enjoyed reading your thoughtful article on support part-ners’ presence during placement of labor epidurals (“Pres-ence of Family Members During Placement of Neuraxial Labor Analgesia,” Winter 2009 SOAP Newsletter). We seem to have the most discussions over partners in the operating rooms: how many to allow, etc. Recently I got a “double whammy” – two dads down. During an epidural place-ment in a birth room, one dad hit the floor, and after a lot of back and forth – “I’m fine, I’m fine” – but no radial pulse, I ordered him to stay down on the floor until we told him he could get up. Immediately after that experience, I walked into the operating room to find a dad sitting on the floor during a cesarean delivery. I had him scoot out so he could get his mask off and had him lie down on the floor, where a student nurse anesthetist stayed with him. I informed both individuals that we could do little more for them; if they fainted again, they would have to be taken to the emergency room and would perhaps miss their child’s birth – and they would not be the first dads to do so.

The moral of the story? Sit down to stay around!

Sign me, Testy on the TundraPaula Craigo, M.D.Mayo Clinic

Letters to the Editor

Teacher of the Year Award

Nominees Sought

The SOAP Education Commit-tee seeks nominations for the SOAP Teacher of the Year Award. Contact Mark Zakowski at mark.zakowski@cshs.org if you would like to nominate a worthy candidate.

Are you registered for the SOAP 2010 Annual Meeting,

“Emerging Technologies in Obstetric Anesthesia”?

Come join us in San Antonio at the Grand Hyatt Hotel May 12-16, 2010.

Visit the SOAP Web site at www.SOAP.org to sign up.

15

Barbara M. Scavone, M.D.Northwestern University Feinberg School of MedicineEditor, SOAP Newsletter

In a recent issue of An-esthesia & Analgesia, Se-gal and Arendt1 added to the debate regarding the use of air versus saline for loss of resistance when ad-ministering an epidural or combined spinal-epidural anesthetic. They retrospec-

tively analyzed records from over 900 patients who re-ceived neuraxial labor analgesia and determined compli-cation rates were lower when anesthesiologists used the technique of their choice rather than the alternative. They pointed out that some randomized, controlled tri-als may be flawed if opera-tors are forced to adopt a loss of resistance medium with which they are not fa-miliar and that reported complication rates in such studies may be falsely elevated.

In addition to the well discussed conclusions in the pa-per, their study raised some interesting points regarding human behavior. It seems that it is difficult for clinicians to adopt new ways of doing things. That being the case, then rather than asking, “What should I be doing?” it may be more important for an educator to ask, “What should I be teaching?” When the technique of preference is used, complication rates are acceptably low with either air or saline. However, there does seem to exist an increased risk of headache due to pneumocephalus with air2 as well as an increased incidence of unblocked dermatomal seg-ments.3 Also, it is worth noting that none of the random-ized, controlled trials demonstrate superiority for air. Per-haps it makes sense for trainees to employ saline for loss of

resistance from the beginning of training, so that it even-tually becomes their technique of choice.

Human beings are resistant to change and probably grow more resistant over time. Such resistance probably colors our reading of the literature. The publications in-vestigating the use of air versus saline certainly have limi-tations; among them is the possibility that use of a novel technique may exaggerate differences. However, it seems unlikely that this type of phenomenon can explain the out-come differences in randomized, controlled trials entirely.

In the interest of full disclosure, I must admit that I am a long-time air user, and have been defending my choice for years. But it is getting harder and harder to defend, and I am led to wonder how much my own bias (I like air!) and aversion to change have influenced my interpretation of the literature. While I was busy noting weaknesses in pub-lished trials that revealed the superiority of saline, did I re-

ally never notice that none of them ever showed any advantages for air? I have been wondering enough that I have decided that, old adages aside, an old dog can learn new tricks, at least when that old dog

has been charged with training young practitioners. I have recently begun teaching my residents to adopt loss of resis-tance to saline as their technique of choice.

References:Segal S, Arendt KW. A retrospective effectiveness study of loss of 1. resistance to air or saline for identification of the epidural space. Anesth Analg. 2010; 110:558-563.Aida S, Taga K, Yamakura T, et al. Headache after attempted epidu-2. ral block: the role of intrathecal air. Anesthesiology. 1998; 88:76-81.Shenouda PE, Cunningham BJ. Assessing the superiority of saline 3. versus air for use in the epidural loss of resistance technique: a lit-erature review. Reg Anesth Pain Med. 2003; 28:48-53

Coda

“Human beings are resistant to change and probably grow more resistant over time. Such resistance probably colors our reading of the literature.”

Remember to renew your SOAP membership!

Visit www.SOAP.org to renew online.

16

Immediate Past PresidentLinda S. Polley, M.D.Ann Arbor, MI

PresidentLawrence C. Tsen, M.D.Boston, MA

President-ElectRobert D’Angelo, M.D.Clemmons, NC

First Vice PresidentMaya S. Suresh, M.D.Houston, TX

Second Vice PresidentMcCallum R. Hoyt, M.D., M.B.A.Boston, MA

TreasurerJohn T. Sullivan, M.D.Chicago, IL

SecretaryBarbara Scavone, M.D.Chicago, IL

Journal LiaisonWilliam R. Camann, M.D.Waban, MA

Chair, ASA Committee on Obstetric AnesthesiaCraig M. Palmer, M.D.Tucson, AZ

Newsletter & Website EditorBarbara Scavone, M.D.Chicago, IL

Meeting Host 2009Robert R. Gaiser, M.D.Mount Laurel, NJ

Meeting Host 2010Manuel Vallejo, M.D.Wexford, PA

Meeting Host 2011Kenneth Nelson, M.D.Winston-Salem, NC

Director at LargeKathryn J. Zuspan, M.D.Edina, MN

Representative: ASA House of DelegatesRichard N. Wissler, M.D., Ph.D.Pittsford, NY

ASA Alternate DelegateDavid J. Wlody, M.D.Brooklyn, NY

Society for Obstetric Anesthesia and Perinatology2009-2010 Board of Directors

520 N. Northwest HighwayPark Ridge, IL 60068-2573