The 31st annual meeting of SOAP was held at the Marriott Hotel in the beautiful city of Denver, Colorado, portal to the West. Nestled in the spectacular Rocky Mountains, Denver provided all the ingredients necessary for a successful scientific meeting, mild weather with warm sunny days and cool dry nights, excellent cuisine, spectacular outdoor activities and of course, a brilliantly conceived scientific program. Beginning on May 19, 1999, SOAP members from around the world gathered. Four hundred and thirty-one members were in attendance.
This year's meeting featured a unique blend of old and new activities to usher in the new millennium and set the stage for SOAP's success in the next 30 years. In addition to the traditional presentations of selected scientific papers in oral, poster and discussion formats, the meeting featured a series of debates on controversial topics, and two eponymous lectures, the Fred Hehre Lecture and the Gerard W. Ostheimer Lecture. Other highlights included the Gertie Marx Symposium for the best resident/fellow paper, breakfast with the experts, a case-based group discussion of fascinating cases, and the presentation of SOAP's first media award.
On May 19th as many participants were arriving in Denver, Dr. David Birnbach assembled a group of directors and members for a strategic planning session to review the current health of SOAP and develop a plan for a successful future. The group worked diligently to develop a new mission statement for SOAP to reflect the present and future needs and desires of the membership. From the session SOAP members are likely to see a new name for the organization to reflect the organization's emphasis on obstetric anesthesia as opposed to perinatology and neonatology (both of which have dedicated scientific societies). Members will see more educational content in upcoming meetings and a new director from the ranks of the private practitioners. These measures and others will help SOAP grow, prosper, and better serve its membership. Many of the strategic planning group's recommendations will require by-laws changes which will be presented in this SOAP newsletter and on the SOAP website (www.soap.org).
The Welcome Reception was held on May 19th at the Top of the Rockies an upscale meeting facility at the site of the old Petroleum Club, giving members a panoramic view of the city and the magnificent Rocky Mountains. Food, drink and company were all outstanding. After a night of refined revelry, Dr. Joy Hawkins (Denver, CO) the host for SOAP '99 opened the meeting early Friday morning in the grand ballroom of the Denver Marriott. After making housekeeping announcements, Dr. Hawkins introduced Dr. David Birnbach, SOAP President. Dr. Birnbach opened the scientific session with the Gertie Marx Symposium, a competition for the best resident or fellow scientific paper named for Professor Emeritus Marx, the grand dame of American obstetric anesthesia. Six papers were chosen from resident submissions for the competition.
Dr. Sakawi (University of Alabama) presented "Evaluation of an Endotoxin-mediated Rodent Model for Pre-eclampsia", concluding that while the model simulated pathologic changes its physiologic manifestations were not similar to human pre-eclampsia.
Dr. Gottumukkala (UTSM Dallas) presented "Assessment of Platelet Function Using Modified Thromboelastography in Women with Severe Pre-eclampsia and Thrombocytopenia", failing to show a significant benefit for TEG as a predictor of platelet function in this troubling condition. Dr. Sakawi presented a second paper entitled "Role of Nitric Oxide in an Endotoxin-mediated rodent model of pre-eclampsia". While the abstract supported a role for both endotoxin and nitric oxide in the development of pre-eclampsia, the presentation failed to make a convincing argument for this theory.
Dr. Weineger (Hadassah University, Jerusalem, Israel) presented "Epidural PCA and the Progress of Nulliparous Labor: Prospective Randomized Study Comparing 0.0625% and 0.25% Bupivacaine". The authors demonstrated a benefit in patient satisfaction and c-section rate when larger volumes of dilute local anesthetic solutions were employed for labor analgesia.
Dr. Hess (Beth Israel Deaconess, Boston, MA) presented "The Timing of Breakthrough Pain During Normal and Dysfunctional Labor", concluding that dysfunctional labor was associated with increased demand for local anesthetic-opioid boluses. The study was criticized for its failure to compare c-section rates among the groups and the lack of IUPC data as a criterion for dysfunctional labor.
Dr. McLeod (Royal Free Hospital, London, U.K.) presented "An Assessment of Maternal Balance and Gait Using Computerized Posturography", concluding in a very technical and elegant analysis that while pregnant women lose balance and motor control when compared to their non-pregnant counterparts, combined spinal-epidural analgesia had no additional effects.
The Gertie Marx prizes were awarded at the SOAP Banquet. Dr. Andrew McLeod received the first place prize, Dr. Yasser Sakawi the second place prize and Dr. Carolyn F. Weiniger the third place prize. All contestants were congratulated on their excellent work.
Following the Symposium and a break to review poster presentations and visit with exhibitors, Dr. Susan Townsend (University of Colorado, Denver, CO) delivered the traditional What's New in Neonatology? Lecture entitled "Ethical Issues at the Intersection of Neonatology and Anesthesia". Dr. Townsend's lecture dealt with ethical dilemmas surrounding the use of neonatal resuscitation in the delivery suite.
Following the lecture and a series of oral presentations moderated by Dr. Mark Norris (St. Louis, MO) SOAP members assembled for the first debate, "Ambulation is Permissible and Safe During Neuraxial Analgesia for Labor." With Dr. Trevor Thomas (Bristol, UK) moderating, Drs. David Birnbach (New York, NY) and Andrew Malinow (Baltimore, MD) argued the pro and con positions, respectively. Dr. Thomas concluded that Dr. Malinow converted more members to his side than Dr. Birnbach and gave his position the technical win for this entertaining debate.
The scientific sessions on the first meeting day concluded with a series of oral presentations moderated by Dr. David Hood (Winston-Salem, NC) and a poster review presented by Dr. Donald Penning (Durham, NC).
The first day concluded with the Annual Business Meeting led initially by out-going SOAP President David Birnbach who ceremoniously turned over the reigns to the new President, David Chestnut. Dr. Birnbach opened the business meeting by showing the audience a videotape of the First Annual SOAP Media Award presented to actress Rachel Ward for her 1994 article in Mirabella Magazine about the benefits of epidural analgesia for labor. Dr. Birnbach impressed the audience with the significance of this presentation and encouraged all members to look for suitable candidates for next year's award.
Other highlights included:
The business meeting concluded with the selection of Phoenix, AZ as the site of SOAP 2002. Friday began with a special presentation, "Practice Management in Obstetric Anesthesia" moderated by Dr. Patricia Dailey (Hillsborough, CA). Attendance at this early morning session was outstanding indicating SOAP members' interest in this topic. The first scientific session of the day was the second in the series of debates, "Neuraxial Opioid Analgesia is the Standard of Care for Post Cesarean Analgesia. With Dr. Samuel Hughes (San Francisco CA) moderating, Drs. Valerie Arkoosh (Philadelphia, PA) and Susan Palmer (Denver, CO) squared off taking pro and con positions, respectively. The debate was both edifying and entertaining, but ended in a draw.
Following the second debate, Dr. Larry Gilstrap (University of Texas, Houston, TX) presented the What's New in Obstetrics? Lecture to a full house. Dr. Gilstrap updated the members on recent topics in the obstetric literature including the prevention of HIV transmission in the neonate, new thoughts on the risk factors for cerebral palsy, prophyllactic use of antenatal corticosteroids, and the safety of vacuum extraction.
After the first informative set of oral presentations in the competition for best paper of the meeting, moderated by Dr. Marianna Crowley (Boston, MA), Dr. Sheila Cohen (Stanford University, Stanford, CA) delivered the first eponymous lecture of the meeting, the annual Fred Hehre Lecture. Dr. Cohen reviewed the important developments in obstetric anesthesia which have occurred during her 25 years as an obstetric anaesthetist (from methoxyflurane to intrathecal opioids), assigning them a grade from A to F based on their impact on the specialty and their success as promoted. Dr. Cohen's presentation was déjà vu for the experienced and an eye-opener for the novices in the audience. After the daily poster review hosted by Dr. David Wlody (Brooklyn, NY) SOAPers had the afternoon free to enjoy Denver or participate in the annual Fun Run or Golf Outing. The day ended with the SOAP Banquet.
Saturday started very early with the Breakfast with the Experts hosted by Dr. Chris Rout (Kwazula-Natal, South Africa). Participants gathered at tables with faculty members to formulate anesthetic plans for several complex obstetric cases. After each group had finished their plans, Dr. Rout led a discussion of the merits of each group's plan presenting a final diagnosis and case disposition. It was good that breakfast was over since each of the cases involved an unusual case of "worms".
The scientific sessions began with the third debate pitting Dr. Barbara Leighton (MCP Hahneman University, Philadelphia, PA) against Dr. Scott Segal (Brigham & Women's Hospital, Boston, MA) on the thesis that "General Anesthesia Is Safe and Appropriate for Immediate Post-Partum Tubal Ligation". Consistent with the skill of each of these orators, the debate ended in a draw according to the moderator, Dr. Sally Weeks (Royal Victoria Hospital, Montreal, Quebec, Canada).
After the third round of oral presentations moderated by Dr. Richard Wissler (Rochester, NY), Dr. McCallum Hoyt (University Hospitals, Cleveland, OH) presented the second eponymous lecture of the meeting, the Gerard W. Ostheimer What's New In Obstetric Anesthesia? Lecture. Dr. Hoyt took the audience on a whirlwind tour of the scientific literature as it relates to the practice of obstetric anesthesia, critically analyzing the papers for scientific merit and clinical relevance.
Following Dr. Hoyt's presentation, two awards were presented. The first, the Zuspan Award for the best obstetric paper of the meeting, went to Kenneth Leveno, MD, University of Texas, Dallas, TX for the paper entitled "Intensity of Labor Pain and Cesarean Delivery". The second award, the Best Paper of the Meeting, went to Linda S. Polley, MD, University of Michigan, Ann Arbor, MI for "Effect of Intravenous vs. Epidural Fentanyl on the Minimum Local Analgesic Concentration (MLAC) of Epidural Bupivacaine in Labor".
Dr. Andrew Harris (Baltimore, MD) moderated the fourth and last SOAP debate, "All Laboring Patients Who Request Epidural Analgesia Should Receive It". Dr. Gerard Bassell (Wesley Medical Centers, Wichita, KS) presented the pro position with Dr. Robert Miller (Obstetrical Anesthesia Associates, St. Louis, MO) taking the con position. Ending the debates and the meeting with such a controversial subject left the audience with a great deal to ponder on the way home.
Dr. David Chestnut adjourned the 31st Annual Meeting of the Society thanking Dr. Joy Hawkins for her hard work as meeting host and thanking the membership for their continued support of obstetric anesthesia and SOAP. On to Montreal!!
Gerald Burger, MD
Chair, Publications Committee
Casper, WY