Newsletter Newsletter - Society for Obstetric Anesthesia and ...

Society for Obstetric Anesthesia and Perinatology 

David J. Wlody, MD 

Greetings to the members of SOAP, and to 

all those who are interested in the anesthetic 

care of the pregnant woman. As the New 

Year begins, there is ample evidence that 

both our Society and the subspecialty of 

Obstetric Anesthesiology are healthy, and 

poised for what I believe will be a period of 

unprecedented growth. 

The Obstetric Anesthesiology program at 

this year’s ASA Annual Meeting in Chicago 

was, once again, extremely successful. The 

SOAP-Sol Shnider Breakfast Panel, entitled 

“Can obstetric anesthesia affect long-term 

maternal and newborn outcome?”, was very 

well attended. Dr. Barbara Leighton of 

Washington University, Dr. William 

Grobman of the Department of OB-GYN at 

Northwestern University, and Dr. Patricia 

Lavand’homme of the Université Catholique 

in Brussels delivered comprehensive 

presentations on the effects of anesthetic 

technique on breastfeeding success, pelvic 

floor dysfunction, and the development of 

chronic post-Cesarean pain, respectively. 

The SOAP/Anesthesiology scientific paper 

special session showcased six outstanding 

papers in the field of OB anesthesia. These 

sessions, as well as the refresher course 

lectures, pro-con debates, and all of our 

other offerings made this year’s Annual 

Meeting a showcase for our subspecialty. 

The political activities of the ASA were 

equally important to Obstetric Anesthesiology. 

www.soap.org 

The ASA House of Delegates approved a 

revision of the Practice Guidelines for 

Obstetric Anesthesia, marking the first 

change in this document since 1998. This 

revision incorporates almost ten years of 

obstetric anesthesia research, and represents 

the state of the art for the anesthetic care of 

the pregnant woman. It can be downloaded 

at the ASA website: 

http://www2.asahq.org/publications/ 

Many thanks to the members of the ASA 

Task Force on Obstetric Anesthesia, and to 

the Task Force chair, Joy Hawkins, for all 

their hard work. 

Many of you are familiar with Anne 

Maggiore and her team at the International 

Anesthesia Research Society, who have 

provided management services to SOAP 

since 2003. SOAP has been very pleased 

with the service provided by IARS, and 

wished to continue this relationship. 

Unfortunately, we have been notified by 

IARS that they will no longer be able to 

provide management services to SOAP 

effective December 31, 2007. SOAP sent out 

a Request for Proposal in August, and for the 

past several months, the Board of Directors 

has been evaluating management proposals 

that have been submitted to us. It is the 

Board’s goal to select a firm that is 

experienced with the management of an 

anesthesiology society, and that can provide 

excellent service within fiscally responsible 

constraints. The Board hopes to make a 

selection prior to the Annual Meeting in 

Banff, in order to permit our new team to 

observe the meeting firsthand. 

I am sure that many of you are interested in 

the status of our application to the 

Accreditation Council on Graduate Medical 

Education (ACGME) for accreditation of 

Newsletter 

President’s Message 

January 2007 

training in Obstetric Anesthesiology. The 

formal application has been submitted to 

ACGME, and as of this writing, plans are 

being finalized for representatives of SOAP 

to meet with ACGME within the next 

several months. For reasons I recounted in 

my last President’s message, the success of 

this effort is of critical importance to our 

subspecialty. SOAP leadership will keep you 

informed of the progress of our application. 

It seems that a constant during my career in 

obstetric anesthesiology has been the 

publication, and subsequent wide dissemination 

to the general public, of articles 

suggesting a causal relationship between 

epidural analgesia and various adverse 

effects on the mother or her newborn—a 

relationship which is often eventually 

disproved, with much less fanfare than the 

original report. From long-term effects on 

the intellectual development of the newborn, 

to the development of chronic headache, to 

an increased incidence of cesarean section, 

we spend much continued on page 2 

Inside 

OAPEF Contribution Listing . . . . . . . . . . . 2 

39th Annual Meeting 

Scientific Program . . . . . . . . . . . . . . . . . . 3 

Syllabus . . . . . . . . . . . . . . . . . . . . . . . . . .4 

PRO/CON Debate . . . . . . . . . . . . . . . . . . . .6 

SOAP Future Meetings . . . . . . . . . . . . . . . .9 

SOAP Membership Committee Report . . . 10

President’s Message–continued from page 1 OAPEF Contributions 

of our time responding to concerns that are 

unsubstantiated by the medical literature, but which 

are nevertheless highly disturbing to our patients. 

The most recent of these was a study, widely 

reported in the news media in mid-December, that 

claimed to demonstrate that women who received 

epidural analgesia were more likely to have 

difficulty breastfeeding in the first week after 

delivery, and were twice as likely to have given up 

breastfeeding at six months after delivery. The study, 

by Torvaldsen et al., entitled “Intrapartum epidural 

analgesia and breastfeeding: a prospective cohort 

study” can be found at in an online-only journal at: 

http://www.internationalbreastfeedingjournal.com 

The findings comprise a secondary analysis of a 

database collected for a different study in Australia in 

1997. In an interview with Reuters news service, the 

lead author was quoted that the most important 

message is that women who receive epidurals should 

receive additional help with breastfeeding, but also 

that the results of this study should be used to enable 

women to make informed decisions about analgesia 

during labor. There are methodologic problems with 

this study that, in my view, render the results 

completely unreliable (Table 1). Unfortunately, none 

of the news articles that I have read were written with 

enough scientific rigor to address any of these 

shortcomings, and presented the study as gospel truth. 

TABLE 1 

Methodologic Shortcomings-Torvaldsen et al. 

1. Non-randomized study—selection bias is likely. 

2. Mixed vaginal and cesarean deliveries—when 

vaginal deliveries were analyzed separately, NO 

association between analgesia and breastfeeding 

3. All women receiving an epidural also received 

parenteral meperidine 

4. No dose-response relationship demonstrated 

5. Despite the alarming tone of many of the media 

reports, both the study author and an accompanying 

editorial clearly state that a causal relationship 

cannot be demonstrated by these findings. 

Comments courtesy of William Camann, MD 

It is easy enough to become disheartened by such 

episodes, but the world is not necessarily a fair 

place, and on the scale of injustice this is a small 

one. It is our task to be familiar with the 

(mis)information that is circulating among our 

patients, to be able to address, accurately and 

dispassionately, the merits or lack thereof of these 

studies, and to support our colleagues who perform 

the research that provides the basis for what we do 

every day. It is in this fashion that we can truly be 

advocates for our patients, their newborns, and the 

generations to come. 

Good luck, and best wishes for the coming year. 

November 1, 2005 – December 15, 2006 

Donors

SOAP 39th Annual Meeting – Scientific Program 

Wednesday, May 16, 2007 

7:00 - 2 pm Simulation Workshops 

1:00 - 5:15 pm Japanese Society of Anesthesiology 

SOAP Symposium (Simultaneous Japanese 

Translation) 

Gurinder M. S. Vasdev, MD; et al. 

1:00 - 5:00 pm American Academy of Pediatric Neonatal 

Resuscitation Certification Program 

6:00 - 8:00 pm Reception 

Thursday, May 17, 2007 

6:00 am-5:00 pm Registration 

6:45 - 8:00 am Breakfast with Exhibitors and Poster Review 

8:00 - 10:00 am Spouse and Guest Hospitality 

7:45 - 8:00 am General Assembly 

Welcome to the 39th Annual SOAP Meeting: 

David J. Wlody, MD, President; Raouf Wahba, MD, 

FRCPC, Host; Gurinder M.S. Vasdev, MD, FRCA, 

Chair 

8:00 - 9:30 am Gertie Marx: Research Competition 

Moderator: Alan C. Santos, MD 

Judges: William R. Camann, MD; Andrew Harris, 

MD; Gordon Lyons, FRCA; Linda S. Polley, MD; 

Maya S. Suresh, MD 

9:30 - 9:45 am Distinguished Service Award 

Presented to Frank James, MD by SOAP President 


9:45 - 10:15 am Coffee with Exhibitors/Posters 

10:15 - 11:00 am PRO/CON Debate: Neuraxial Techniques 

for Labor Analgesia Should be Placed in 

the Lateral Position 

Moderator: John Thomas, MD 

Pro: Lawrence C. Tsen, MD 

Con: Linda S. Polley, MD 

11:00-12:00 pm Oral Presentations #1 

Moderator: Mark Rosen, MD 

12:00 - 1:00 pm Lunch with Exhibitors and Poster Review 

1:00 - 2:00 pm What’s New in Obstetrics? 

Introduction: Raouf Wahba, MD, FRCPC; 

Presenter: Michael Helewa, MD, FRCPC 

2:00 - 3:00 pm Zuspan Award: Research Competition 

Moderator: Vernon Ross, MD 

Judges: Linda Barbour, MD, MSPH; Michael 

Helewa, MD, FRCPC; Edward T. Riley, MD; Junzo 

Takeda, MD; Kathryn Zuspan, MD 

3:00 - 3:30 pm Coffee Break with Exhibitors and Poster Review 

3:30 - 6:00 pm SOAP Business Meeting – Awards Presentations 


_______________ 

6:00 - 9:00 pm Residents/Fellows/Students Only Forum 

(Trainees & Mentors) 

Session Chair: Gurinder M.S. Vasdev, MD 

6:00 - 7:00 pm Welcome Reception for Trainees 

David J. Wlody, MD, President, SOAP 

7:00 - 7:30 pm Poster Review 

— 3— 

7:30 - 8:00 pm Oral Presentations 

Judges: Terrance Breen, MD; M. Joanne Douglas, 

MD, FRCPC; Helene Finegold, MD; 

Joanne C. Hudson, MD; Linda S. Polley, MD; 

Monica Riesner, MD; Barbara Scavone, MD 

8:00 - 8:45 pm Resident Lecture: Professionalism in 

Anesthesiology through SOAP 

Joanne Hudson, MD 

Friday, May 18, 2007 

6:00 am-12 noon Registration 

6:45 - 8:00 am Breakfast with Exhibits and Poster Review 


6:45 - 7:45 am Breakfast with the Experts 

Co-Chairs: David Campbell, MD, MSc, FRCPC; 

Michael Paech, MD 

Experts: Brendan Carvalho, MB, BCh; Jose Carvalho, 

MD, PhD, FRCPC; Sheila E. Cohen, MB, ChB, 

FRCA; Lesley-Ann Crone, MD, FRCPC; M. Joanne 

Douglas, MD, FRCPC; Roshan Fernando, FRCA; 

David Gambling, MD, FRCPC; Stephen Halpern, 

MD, FRCPC; David Hepner, MD; Robert S. 

McKay, MD; Dolores McKeen, MD, FRCPC; Jill 

Mhyre, MD; Pam Morgan, MD, FRCPC; Holly Muir, 

MD, FRCPC; Kenneth E. Nelson, MD; Toshiyuki 

Okutomi, MD; Quisqueya Palacios, MD; Craig 

Palmer, MD; Donald H. Penning, MD, MSc, FRCP; 

Roanne Preston, MD, FRCPC; Maya S. Suresh, MD; 

Katsuo Terui, MD; Ashu Wali, MD, FFARCSI; 

Cynthia Wong, MD 

8:00 - 9:00 am Poster Review #1 

Moderator: Yaakov Beilin, MD 

9:00 - 10:00 am What’s New in Obstetric Medicine? 

Introduction: William R. Camann, MD 

Speaker: Linda Barbour, MD, MSPH 

10:00 - 10:30 am Coffee with Exhibitors and Poster Review 

10:30 - 1:00 pm Patient Safety Session 

Chair: Stephen Pratt, MD 

10:30 - 11:15 am Role of Simulation in Teaching Obstetric Anesthesia 

Speaker: John Sullivan, MD 

11:15 - 12:15 pm Pro-Con Debate #2: Crew Resource 

Management in Medicine is a Fad 

Moderator: May Pian-Smith, MD, MS 

Pro: Richard N. Wissler, MD, PhD 

Con: John Pawlowski, MD 

12:15 - 1:00 pm The Impact of National Patient Safety Goals 

from the Joint Commission on the Accreditation 

of Healthcare Organization for Obstetrics and 

Obstetric Anesthesia 

Speaker: Edward Molina-Lamas, MD, FACA 

1:30 pm Golf Tournament : Fairmont Banff Springs Golf 

Course (includes lunch) 

2:00 - 6:00 pm Social Afternoon (lunch on your own) 

Fun Run/Walk; Horseback Riding; Nature Trails; SPA 

7:00 - 11:00 pm The SOAP Ball (Party attire)

SOAP 39th Annual Meeting – Scientific Program 

Regional Workshop in Obstetric Anesthesia - Optional 

2:00 - 4:45 p.m. Regional Workshop in Obstetric Anesthesia 

(By Ticket Only - Limited Registration) 

Director: Jose Carvalho, MD, PhD, FRCPC 

Faculty: Cristian Arzola, MD; Mirinalini Balki, 

MD; Jose Carvalho, MD, PhD, FRCPC; 

Barry Harrison, MD, FANZCA; James Hebl, MD; 

Shreeniwas Jawalekar, MD; Sandra Kopp, MD; 

Krzysztof M. Kuczkowski, MD; Hugh Smith, MD, 

PhD; Jack Wilson, MD 

Program 

2:00 - 2:45 p.m. Introduction to Ultrasound and Case Examples 

(participants divided into two groups) 

2:45 - 3:30 p.m. Group 1: Ultrasound with models 

Group 2: Glass spine demonstration, CSE 

Simulator, Tsui Test Simulator 

3:30 - 4:00 p.m. Break (re-set stations) 

4:00 - 4:45 p.m. Group 1: Glass spine demonstration, CSE 

Simulator, Tsui Test Simulator 

Group 2: Ultrasound with models 

Saturday, May 19, 2007 

6:00 am-12 noon Registration 


6:30 - 7:45 am Breakfast Panel: Genomics in Obstetric Anesthesia 

Chair: Richard Smiley, MD, PhD 

Speakers: William Hartman, MD, PhD; 

Ruth Landau, MD 

8:00 - 9:00 am OB Anesthesia Research: 

The Unanswered Questions 

Speakers: Robert D’Angelo, MD; Philip Hess, MD; 

Barbara Leighton, MD; Edward Riley, MD; 

Scott Segal, MD; Richard Smiley, MD, PhD 

9:00 - 10:00 am Gerard W. Ostheimer Lecture: 

What’s New in OB Anesthesia? 

Introduction: Roshan Fernando, FRCA 

Speaker: Alison Macarthur, MD, MSc, FRCPC 

10:00 - 10:15 am Break 

10:15 - 11:15 am Oral Presentation #2 

Moderator: Michael Froelich, MD 

11:15 - 12:15 pm Fred Hehre Lecture: Malpractice or 

Miscommunication? The Importance of Improved 

Communication between Anesthesiologists, 

Patients and our Colleagues 

Introduction: David J. Wlody, MD 

Speaker: David J. Birnbach, MD, MPH 

12:15 - 1:00 pm Lunch (on your own) 

1:00 - 2:00 pm Best Paper Presentations 

Moderator: Gordon Lyons, FRCA 

Judges: Theodore Cheek, MD; McCallum Hoyt, MD; 

Geraldine O’Sullivan, FRCA; Alex Pue, MD; 

Michael P. Smith, MD, MS Ed; 

Rakesh Vadhera, FRCA 

2:00 - 3:00 pm Best Case Reports: You Did What? 

Moderator: Robert Gaiser, MD 

3:00 - 3:15 pm Break 

3:15 - 4:00 pm Poster Review #2 

Moderator: Moeen K. Panni, MD 

— 4— 

4:00 - 5:30 pm Panel on Infection after Neuraxial Anesthesia 

Chair: Peter H. Pan, MD 

Panelists: Joy Hawkins, MD; Terese T. Horlocker, 

MD; Samuel Hughes, MD; Ruth Landau, MD 

6:00 pm Transportation to Mountain View Barbeque 

6:00 - 10:30 pm Mountain View Barbeque - Optional Event 

A place where the starry mountain views are 

breathtaking and the western hospitality abounds! 

Mosey on in to the famous “Donut Tent,” a round 

log building with a hole in the center - built 

specifically for blazing bonfires. Please sign up for 

this event at www.roadwest.com/soap. 

SOAP 39th Annual Meeting 

May 16-19, 2007 

FAIRMONT BANFF SPRINGS, ALBERTA, CANADA 

SOAP had an excellent year in 2006, thanks to the outstanding efforts 

of Bill Camann and David Wlody. We achieved many of our goals at 

the 38th annual meeting in Hollywood, Florida with a large attendance 

and an outstanding program. Our excellent financial performance in 

2006 is helping us build a stronger SOAP for the future. Setting our 

course for 2007 is actually quite simple: Concentrate on what we do 

best—and make it even better! We ensure that the quality of research 

and education presented at SOAP are so unique and valuable that they 

will always be in demand. As program chair and host for SOAP 2007, 

it is our honor to invite you to attend the 39th Annual Meeting in Banff, 

Alberta, Canada. This meeting will feature some of the brightest and 

most talented physicians who will share recent advances in obstetric 

anesthesia. This is a strong forum for obstetric anesthesia; not only 

highlighted by the scientific program but by the social events as well: 

All this in a picture postcard setting. 

The Scientific Program 

This starts with pre-meeting workshops. We are proud to introduce 

2.25-hour hands on simulation session. There will be real-time 

simulated OB disasters, which the participants must manage (please 

wear comfortable clothing). We have invited simulation education 

experts from the Mayo Clinic and Magee Women’s Hospital with 

the current state of the art medical simulators to teach this course. 

Please register early, as there is limited space. 

We are also pleased to offer re-certification in Neonatal Resuscitation 

(NRP). As you all know the American Academy of Pediatrics recently 

revised the NRP. Our course will highlight these changes and review 

the pertinent details for re-certification. Pre-registration is 

mandated, so we can mail the required reading materials to you. 

Satisfactory completion of this course will result in a 2-year 

certification from the American Academy of Pediatrics. Space is 

limited and registration is on a first come first served bases. 

SOAP extends a warm welcome to the Japanese Society of Anesthesiology 

(JSA). A joint Pre-meeting symposium represents an 

important link for our society and the emerging subspecialty 

continued on page 5

continued from page 4 

SOAP 39th Annual Meeting – May 16-19, 2007 

of Obstetric Anesthesia in Japan. We are confident both SOAP and 

JSA members will enjoy this forum of international exchange 

creating an environment to foster collaborative research, education 

and clinical practice. 

We encourage you not to miss the SOAP reception on Wednesday 

evening. It is a great chance to mingle with other SOAP members in 

a wonderful atmosphere in the “Castle in the Rockies.” 

Thursday, May 17, 2007, our formal meeting opens with the Gertie 

Marx: Research Competition. For those coming to SOAP for the first 

time, this is a great opportunity to win a prize at SOAP. The papers 

selected for the award are judged on the day. The Zuspan Award and 

Best Paper awards are other prizes that encourage academic contributions 

from our obstetrician and obstetric medicine colleagues. 

One of the most enjoyable portions of our meeting is the debates. In 

calling the first question, Laurence Tsen and Linda Polley will debate 

“the correct position for initiation of neuraxial blocks.” For our second 

question, Richard Wissler will go head to head with John Pawlowski 

debating whether “crew resource management in medicine is a fad.” 

We are privileged to have Dr. Michael Elias Helewa, Past 

President/Président sortant of The Society of Obstetricians and 

Gynaecologists of Canada, deliver the “What’s New in Obstetrics?” 

lecture. Our next invited speaker is Dr. Linda Barbour from Denver, 

Colorado. She is Past President of the North American Society of 

Obstetric Medicine, has served on the Pregnancy Council for the 

American Diabetes Association, and chaired the Colorado Clinical 

Guidelines Collaborative for Management of Gestational Diabetes 

for the state health department. She will present the “What’s New in 

Obstetric Medicine” lecture. 

Dr. Alison Macarthur from Toronto, Ontario, Canada is the chair of 

the Obstetric Section of the Canadian Anesthesiologists’ Society. 

She has graciously offered to present the Gerard Ostheimer Lecture: 

“What’s new in Obstetric Anesthesia?”. 

Professor David Birnbach, from Miami, Florida will deliver the honored 

Fred Hehre Lecture. He will discuss the problems associated with 

miscommunications. We believe there will be many eloquent surprises 

in his outstanding presentation. This is truly a “do not miss lecture.” 

What’s new for SOAP in 2007? 

• We have introduced a trainee forum: An opportunity for 

residents, fellows, students and mentors to become more 

involved in SOAP. Our future lies within the young curious 

minds that promote our mission. 

• A primer in genomics has been added to the research hour to 

introduce members to the huge potential for obstetric anesthesia of 

the human genomic project. Just think – one day we will be able 

plan a parturients anesthetic based on a blood test or buccal smear. 

• The Impact of National Patient Safety Goals from the Joint 

Commission on the Accreditation of Healthcare Organization for 

Obstetrics and Obstetric Anesthesia. Much of the demands of 

— 5— 

JCAHO affect us directly or indirectly. Dr. Edward Molina-Lamas 

will unravel the reasons why such mandates have come about and 

he will be open for a question and answer session. 

• The Regional Workshop is an optional event for Friday afternoon 

for those who are unable to join in the social events. The highlights 

include the use of ultrasound for placement of neuraxial block, 

hands-on demonstration of the spinal anesthesia (including microcatheters) 

with the glass spine, CSE simulator and the Tsui test for 

epidural placement. 

• To answer many of the questions regarding neuraxial infection we 

present a panel discussion on “infection after neuraxial 

anesthesia”. This forum will discuss many of the issues 

surrounding anti-sepsis and higlight some of the challenges facing 

the ASA in developing practice advisories. 

Social Events 

No SOAP will ever be complete without memorable social events. 

The following will be offered on our website (www.soap.org). Please 

register early so we can better allocate resources for these events. 

• Welcome to Banff Reception • SOAP Ball (party attire) 

• Golf Tournament • Mountain View Barbecue 

• Fun Run/Walk • Tours of Area Attractions 

• Horseback Riding • SOAP dine around 

Getting to Banff 

Air travel to Banff is via Calgary’s International Airport, which is 

located approximately 80 miles east of the resort. SOAP has made 

special arrangements for discounted round-trip ground 

transportation from the Calgary Airport to Banff. This timesaving 

service is exclusively for SOAP participants. Registrants are 

encouraged to take advantage of this convenient transportation. 

Information is available on the SOAP website and includes a link to 

Road West, here you can make your reservation: 

www.roadwest.com/soap 

The Fairmount Banff Springs is truly a “Castle in the Rockies”. It is 

one of a kind hotel. SOAP has negotiated great rates for SOAP 

participants. Great rates and low Alberta tax structure provide great 

opportunity to enjoy this unique atmosphere. SOAP also arranged 

for a convenient transportation directly from the Fairmont Banff 

Spring Hotel to Calgary International Airport for those who have 

early Sunday departures flights. Please make your reservation 

through Road West link and indicate your departure time. 

Weather everywhere can be unpredictable; Banff in May will 

experience late spring or early summer temperatures. As with all 

mountain climates the evenings will be cool. Those of you who wish 

to travel to the glaciers you should bring appropriate clothes. Banff 

is rated as one of the world’s most beautiful parks by National 

Geographic. Please consider spending a little extra time and enjoy 

great spring skiing at Sunshine Village, golf and horseback riding. 

Do not miss this exceptional opportunity; make plans today to attend 

SOAP’s 39th Annual Meeting at the “Castle in the Rockies”. 

We look forward to seeing you in Banff.

PRO CON 

PRO 

Supplemental Oxygen Should Routinely Be Used 

During Cesarean Section 

Scott Segal, MD 

Brigham and Women’s Hospital 

Harvard Medical School 

Boston, MA 

Am I really defending oxygen?! Anesthesiologists’ use of supplemental 

oxygen during surgical procedures is one of the oldest, most 

fundamental and widely accepted interventions in the specialty. 

However, tradition is not a valid argument and I will attempt to make 

a logical case for the routine use of oxygen. 

To begin, let me propose a syllogism: 

• If an intervention offers significant benefit to all patients, or 

benefits some patients and has neutral effects on all others, and 

• If this intervention does not produce significant adverse effects, 

then 

• The intervention should be routinely used. 

To illustrate this reasoning, consider pulse oximetry or capnography, 

both interventions that truly help very few patients but do so at no 

appreciable risk and so are routinely employed. 

Beneficial effects of oxygen 

There are several direct benefits of oxygen to the mother and 

perhaps the baby: 

1. During maternal anesthetic mishap. Contrary to our wishes, 

regional anesthesia sometimes fails, and general anesthesia is 

needed. A large study showed this occurs 4.3% of the time during 

epidural anesthesia, and 1.2% during spinal anesthesia 1 . If the 

procedure has started, it is a big head start on being able to quickly 

induce general anesthesia. More ominously, unexpected high or 

total spinal occurs often enough to justify precautionary oxygen. 

After epidural block, 1/1400 to 1/4500 patients develop high or 

total spinal bloc. 2,3 Even after routine spinal block, 1/3200 to 

1/30,000 will develop a total spinal. 1,4 Otherwise unexplained 

bradyasystolic cardiac arrest under spinal anesthesia occurs even 

more frequently, 1/1600-1/3700. 5-7 Taking some liberties in my 

estimation of our readership, that means this will happen to 

someone reading this article at least several times a year! 

Does oxygen help when things go wrong? Yes! Half a century ago 

when intravenous anesthetics and controlled ventilation were just 

coming of age, investigators showed that desaturation during apnea 

was much faster in patients breathing room air than in those 

receiving supplemental oxygen. Dillon 8 gave thiopental to induce 

apnea and showed a 50% decrease in PO2 in 4 minutes when 

breathing room air, but only 5% when breathing oxygen. Similarly, 

Weitzner 9 showed SaO2 decreased to 60% in just 1.5 minutes of 

apnea after air ventilation but did not change after oxygen 

ventilation. And even a little oxygen helps vs. none at all. Heller 10 

— 6— 

compared room air to different FiO2’s and showed desaturation in 

just 1 minute on room air vs. 2.5 minutes on 33% O2, and 

supranormal PO2 after 4 minutes when breathing 50 or 100%. Of 

course, all of us appreciate that obesity and pregnancy both lead to 

even more rapid desaturation than in the healthy males studied 

decades ago. 

2. During obstetric mishaps. Rarely and unexpectedly, amniotic 

fluid embolism (AFE) or air embolism can complicate cesarean 

section, leading to sudden cardiopulmonary decompensation. The 

situation would be analogous to that of a total spinal or 

bradyasystolic arrest, in that a longer time before desaturation 

might be expected if the patient were breathing oxygen. Of 

course, no good data exists comparing AFE with or without 

oxygen! More commonly, sudden brisk hemorrhage sometimes 

complicates cesarean section. Oxygen has been shown to 

ameliorate the cognitive dysfunction and tachycardia which 

accompanies severe isovolemic anemia 11 . 

3. Reducing maternal wound infection. Two well-performed 

randomized trials have shown that supplemental oxygen reduced 

wound infection rates after abdominal surgery. 12,13 This remains to 

be demonstrated in cesarean section, but wound infection is 

relatively common in this operation, particularly in the case of 

obesity or ruptured membranes. 

4. Reducing maternal nausea. Some evidence supports a role for 

oxygen in reducing nausea in women receiving spinal anesthesia. 14 

It remains to be demonstrated in cesarean section, but the baseline 

incidence is so high that even a modest effect would be 

welcomed. 

5. The baby. Although the placenta insulates the fetus from 

hyperoxia, increasing maternal FiO2 increases the PO2 in the 

umbilical vein and artery. 15 Using fetal pulse oximetry, Simpson 

and James 16 demonstrated that among common methods for in 

utero resuscitation of the baby (also including fluid bolus and 

position changes), maternal oxygen was the most effective and 

had the greatest effect on fetal oxygenation when the baseline was 

lowest. Although neither proponents nor opponents of oxygen 

have shown any effect on global indices of neonatal well-being, it 

is instructive to note that when the fetus is most vulnerable (low 

SpO2), oxygen has its greatest possible beneficial effect. 

Adverse effects of oxygen are trivial 

Oxygen is one of the best tolerated drugs in our arsenal. In modern 

medicine, cost is not an issue (about a hundredth of a cent per liter, 

or less than a nickel a case!). Some women will complain of 

discomfort or claustrophobia while wearing a mask, but gentle 

reassurance, trimming the mask slightly, or substituting nasal prongs 

are effective ways to improve acceptance. 

Potentially more importantly, oxygen during cesarean section has 

been associated with increased levels of lipid peroxidation in the 

baby. 17-19 This work, done primarily by my opponent, has also 

demonstrated no improvement but also no deleterious effects on the 

fetus or neonate from maternal oxygen administration. This includes 

uterine artery and vein blood gases and Apgar scores. It has also 

been observed that babies resuscitated after birth with room air have 

continued on page 7


PRO CON 

better outcomes than those receiving oxygen. However, in this 

clinical situation, the fragile neonatal cardiorespiratory system is 

exposed to much higher concentrations of oxygen (and postive 

pressure ventilation) than the situation of the fetus exposed 

indirectly in utero. 

Conclusions 

Returning to the original syllogism, oxygen has been shown to have 

real benefits to some mothers and negligible risk to all mothers. The 

risks to the baby, if any, are largely theoretical. Therefore, I argue 

that it should be routine in all cesarean sections. 

References 

1. Pan PH, Bogard TD, Owen MD. Incidence and characteristics 

of failures in obstetric neuraxial analgesia and anesthesia: a 

retrospective analysis of 19,259 deliveries. Int J Obstet Anesth 

2004;13:227-33. 

2. Crawford JS. Some maternal complications of epidural 

analgesia for labour. Anaesthesia 1985;40:1219-25. 

3. Paech MJ, Godkin R, Webster S. Complications of obstetric 

epidural analgesia and anaesthesia: a prospective analysis of 

10,995 cases. Int J Obstet Anesth 1998;7:5-11. 

4. Irita K, Tsuzaki K, Sawa T et al. [Critical incidents due to drug 

administration error in the operating room: an analysis of 

4,291,925 anesthetics over a 4 year period]. Masui 

2004;53:577-84. 

5. Auroy Y, Benhamou D, Bargues L et al. Major complications of 

regional anesthesia in France: The SOS Regional Anesthesia 

Hotline Service. Anesthesiology 2002;97:1274-80. 

6. Auroy Y, Narchi P, Messiah A et al. Serious complications 

related to regional anesthesia: results of a prospective survey in 

France. Anesthesiology 1997;87:479-86. 

7. Caplan RA, Ward RJ, Posner K, Cheney FW. Unexpected 

cardiac arrest during spinal anesthesia: a closed claims analysis 

of predisposing factors. Anesthesiology 1988;68:5-11. 

8. Dillon JB, Darsie ML. Oxygen for acute respiratory depression 

due to administration of thiopental sodium. J Am Med Assoc 

1955;159:1114-6. 

9. Weitzner SW, King BD, Ikezono E. The rate of arterial oxygen 

desaturation during apnea in humans. Anesthesiology 

1959;20:624-7. 

10. Heller ML, Watson TR, Jr. Polarographic study of arterial oxygenation 

during apnea in man. N Engl J Med 1961;264:326-30. 

11. Weiskopf RB, Feiner J, Hopf HW et al. Oxygen reverses 

deficits of cognitive function and memory and increased heart 

rate induced by acute severe isovolemic anemia. 

Anesthesiology 2002;96:871-7. 

12. Belda FJ, Aguilera L, Garcia de la Asuncion J et al. 

Supplemental perioperative oxygen and the risk of surgical 

wound infection: a randomized controlled trial. Jama 

2005;294:2035-42. 

13. Greif R, Akca O, Horn EP et al. Supplemental perioperative 

oxygen to reduce the incidence of surgical-wound infection. 

Outcomes Research Group. N Engl J Med 2000;342:161-7. 

— 7— 

14. Ratra CK, Badola RP, Bhargava KP. A study of factors concerned 

in emesis during spinal anaesthesia. Br JAnaesth 1972;44:1208-11. 

15. Ramanathan S, Gandhi S, Arismendy J et al. Oxygen transfer 

from mother to fetus during cesarean section under epidural 

anesthesia. Anesth Analg 1982;61:576-81. 

16. Simpson KR, James DC. Efficacy of intrauterine resuscitation 

techniques in improving fetal oxygen status during labor. Obstet 

Gynecol 2005;105:1362-8. 

17. Khaw KS, Ngan Kee WD, Lee A et al. Supplementary oxygen 

for elective Caesarean section under spinal anaesthesia: useful 

in prolonged uterine incision-to-delivery interval? Br J Anaesth 

2004;92:518-22. 

18. Khaw KS, Wang CC, Ngan Kee WD et al. Effects of high 

inspired oxygen fraction during elective caesarean section 

under spinal anaesthesia on maternal and fetal oxygenation and 

lipid peroxidation. Br J Anaesth 2002;88:18-23. 

19. Ngan Kee WD, Khaw KS, Ma KC et al. Randomized, doubleblind 

comparison of different inspired oxygen fractions during 

general anaesthesia for Caesarean section. Br J Anaesth 

2002;89:556-61. 

CON 

Supplemental Oxygen Should Not Routinely Be Used 

During Cesarean Section 

Warwick D. Ngan Kee 

BHB, MBChB, MD. FANZCA, FHKCA, FHKAM 

Professor 

Department of Anaesthesia and Intensive Care 

The Chinese University of Hong Kong 

Hong Kong, China 

Introduction 

Based on historical recommendations, it is common for anesthesiologists 

to give supplemental oxygen to patients having cesarean 

section. However, after reviewing the evidence for its use, I stopped 

routinely giving supplemental oxygen during regional anesthesia 

many years ago. Here are the reasons why. 

Physiological considerations 

The human placenta is thought to function as a concurrent exchange 

system. Although this is relatively inefficient, many physiological 

adaptations have evolved to ensure adequate oxygen delivery to and 

within the fetus. On the maternal side, unloading of oxygen in the 

placenta is facilitated by a rightward shift of the oxyhemoglobin 

dissociation curve secondary to increased levels of 2,3-DPG and 

inward diffusion of fetal waste. On the fetal side, although umbilical 

venous (UV) PO2 values (typically around 28-30 mm Hg) are much 

lower than maternal arterial values, the fetus is well adapted to this. 

Adaptations include a high fetal hematocrit comprising mainly fetal 

hemoglobin which has high oxygen affinity, and a high fetal cardiac 

output. This ensures that the fetus is well oxygenated and thus 

attempts to increase fetal PO2 values above the normal physiological 

range are unnecessary. 

continued on page 8


PRO CON 

The rationale for giving supplemental oxygen 

Common reasons given for giving oxygen are to increase fetal 

oxygenation and to increase maternal safety in the event of 

hypotension or hypoventilation. In an early study of patients having 

epidural anesthesia it was demonstrated that administering 

increasing supplemental concentrations of oxygen to the mother 

(21%, 47%, 74% and 100%) resulted in proportional increases in 

UV and umbilical arterial (UA) PO2. 1 However, careful examination 

of the study methodology reveals that: 1) the oxygen was delivered 

at 10L/min via a circle system and an anesthesia facemask, a method 

unlikely to be used in clinical practice; 2) the UA and UV values 

attained were supranormal and thus of doubtful physiological 

benefit; and 3) there was no difference in clinical outcome between 

groups. More recently, Cogliano and colleagues evaluated 

supplemental oxygen during spinal anesthesia. Patients received 

either air by simple facemask, 4 L/min oxygen by simple facemask 

or 2 L/min oxygen by nasal cannulae. 2 They found no difference 

between groups in UA or UV PO2 suggesting that giving oxygen 

using methods that are most likely to be used in actual clinical 

practice have no significant impact on fetal oxygenation. 

It has been suggested that supplemental oxygen should be used 

because hypotension is common during spinal anesthesia. 3 However, 

it is more rational to treat hypotension directly; my recent work 

shows that this is achievable. 4 

Another suggested reason for giving supplemental oxygen is to 

mitigate the effects of spinal anesthesia on respiratory function. 

Kelly et al showed that spinal anesthesia decreased several measures 

of respiration function. 5 However, giving 35% oxygen versus air had 

no beneficial effect on UV PO2 or clinical outcome. Use of a pulse 

oximeter will readily identify patients who require oxygen because 

of impaired ventilatory function, obviating the need to take the 

“shotgun” approach of giving oxygen to every patient. 

A review article published more that 10 years ago suggested that 

increasing maternal oxygenation was useful to build up fetal PO2 as 

there is no oxygen transmission to the fetus after uterine incision. 6 

However, in a randomized controlled trial, we were unable to shown 

any benefit of supplemental oxygen when the uterine-incision to 

delivery time was prolonged. 7 We have found that giving 60% 

oxygen during spinal anesthesia was effective in increasing UV 

PO2, 8 but values attained are greater than those measured in 

vigorous infant delivered vaginally. 9 

It may be thought useful to give oxygen during regional anesthesia 

to prepare for the (rare) event that urgent conversion to general 

anesthesia is required. However, time to achieve adequate 

denitrogenation of the lungs is unlikely to be significantly decreased 

by giving oxygen by simple facemask or nasal cannulae beforehand. 

The potential benefit of supplemental oxygen during emergency 

cesarean section is less clear. Previously, we have found that 

administration of 60% oxygen using a tight fitting venturi mask 

during emergency spinal anesthesia did increase UV PO2 which 

— 8— 

provided a potentially useful increase in oxygen content in patients 

classified as urgent. 10 However, it should be pointed out that a 

concentration of 60% is unlikely to be achieved using simple masks 

and nasal cannulae and in our study there was no difference in 

clinical outcome, including Apgar scores and fetal acidosis between 

patients who received air or oxygen. 

Potential adverse effects of giving oxygen 

It is often intuitively assumed that giving oxygen might do some 

good but will not do harm. However, giving oxygen is not 

necessarily as innocuous as is commonly assumed. 

Application of an oxygen mask or nasal cannulae may be uncomfortable 

and interfere with patient communication. Oxygen and the 

apparatus used to deliver it cost money. Hyperoxygenation has been 

shown to increase markers of oxygen free radical activity in both 

mother and fetus. 8 Although the clinical significance of this is 

undetermined, free radicals have been implicated in a number of 

important pathological processes. Use of the fresh gas flow outlet to 

administer supplemental oxygen during regional anesthesia has the 

potential risk of accidental volatile anesthetic administration and 

failure of preoxygenation in a subsequent urgent case has been 

described because of failure to reconnect the fresh gas tubing. 11 Other 

evidence for potential harm of oxygen include a study that found lower 

fetal pH occurred when oxygen was given to mothers during the second 

stage of labor 12 and data suggesting that outcome during neonatal 

resuscitation may be better when air is used instead of oxygen. 13 

Conclusion 

There is no evidence for a clinically important benefit from giving 

routine supplemental oxygen to healthy patients during cesarean 

section. It should not be assumed that routine administration of 

oxygen is harmless. Use your clinical judgement – and your pulse 

oximeter – to identify the occasional patient who may benefit from 

oxygen. For the others, there is clearly no need. 

References 

1. Ramanathan S, Gandhi S, Arismendy J, Chalon J, Turndorf H. 

Oxygen transfer from mother to fetus during cesarean section 

under epidural anesthesia. Anesth Analg 1982; 61: 576-81. 

2. Cogliano MS, Graham AC, Clark VA. Supplementary oxygen 

administration for elective Caesarean section under spinal 

anaesthesia. Anaesthesia 2002; 57: 66-9. 

3. Mandal NG, Gulati A, Khaw KS, Ngan KW. Oxygen 

supplementation during Caesarean delivery. Br J Anaesth 2004; 

93: 469-70. 

4. Ngan Kee WD, Khaw KS, Ng FF. Prevention of hypotension 

during spinal anesthesia for cesarean delivery: an effective 

technique using combination phenylephrine infusion and 

crystalloid cohydration. Anesthesiology 2005; 103: 744-50. 

5. Kelly MC, Fitzpatrick KT, Hill DA. Respiratory effects of spinal 

anaesthesia for caesarean section. Anaesthesia 1996; 51: 1120-2. 

6. Bassell GM, Marx GF. Optimization of fetal oxygenation. Int J 

Obstet Anesth 1995; 4: 238-43. 

continued on page 9

PRO CON 


7. Khaw KS, Ngan Kee WD, Lee A et al. Supplementary oxygen 

for elective Caesarean section under spinal anaesthesia: useful 

in prolonged uterine incision-to-delivery interval? Br J Anaesth 

2004; 92: 518-22. 

8. Khaw KS, Wang CC, Ngan Kee WD, Pang CP, Roger MS. Effects 

of high inspired oxygen fraction during elective Caesarean section 

under spinal anaesthesia on maternal and fetal oxygenation and 

lipid peroxidation. Br J Anaesth 2002; 88: 18-23. 

9. Arikan GM, Scholz HS, Petru E, Haeusler MC, Haas J, Weiss 

PA. Cord blood oxygen saturation in vigorous infants at birth: 

what is normal? BJOG 2000; 107: 987-94. 

10. Khaw KS, Ngan Kee WD, Wang CC, Ng FF, Rogers MS. 

Supplementary oxygen for emergency cesarean section under 

regional anesthesia. Anesthesiology 2004; 101: A1229. 

11. Stone AG, Howell PR. Use of the common gas outlet for the 

administration of supplemental oxygen during Caesarean 

section under regional anaesthesia. Anaesthesia 2002; 57: 690-2. 

12. Thorp JA, Trobough T, Evans R, Hedrick J, Yeast JD. The effect 

of maternal oxygen administration during the second stage of 

labor on umbilical cord blood gas values: a randomized 

controlled prospective trial. Am J Obstet Gynecol 1995; 172: 

465-74. 

13. Saugstad OD, Rootwelt T, Aalen O. Resuscitation of 

asphyxiated newborn infants with room air or oxygen: an 

international controlled trial: the Resair 2 study. Pediatrics 

1998; 102: e1. 

SOAP Future Meetings 


Fairmont Banff Springs 

“Castle in the Rockies” 

Alberta, Canada 

May 16 - 19, 2007 


Renaissance Chicago Hotel 

Chicago, IL 

April 30 - May 4, 2008 

SOAP 41st Annual Meeting 

Renaissance Washington DC Hotel 

Washington, DC 

April 29 - May 3, 2009 

SOAP 42nd Annual Meeting 

San Antonio, TX 

— 9— 

10 Reasons Why You Should Come to 

The 39th Annual Meeting in Banff 

1. To participate in a hands-on state-of-the-art 

simulation session. 

2. To become certified in Neonatal Resuscitation and 

learn about the new guidelines from AAP. 

3. To learn about what's going on in obstetric 

anesthesia in Japan. 

4. To discuss whether the seated position is optimal for 

labor analgesia via neuraxial techniques. 

5. To discuss whether crew resource management is 

just a fad. 

6. To find out what JCAHO means for obstetric 

anesthesia. 

7. To debate whether ultrasound technologies should 

be used for neuraxial technique placements. 

8. To discuss if we can rationalize practice parameters 

to prevent neuraxial infection associated with 

regional anesthesia. 

9. To visit the not to be missed, one-of-a-kind, picture 

post card setting of Banff. 

10. To attend the many Social Events (details at 

www.soap.org) 

Getting to Banff: 

Air travel to Banff is via Calgary’s International Airport. SOAP has 

made special arrangements for discounted round-trip ground 

transportation from the Calgary Airport to Banff. This timesaving 

service is exclusively for SOAP participants. Registrants are 

encouraged to take advantage of this convenient transportation. 

Information is available on the SOAP web site and includes a link to 

Road West, here you can make your reservation: 

www.roadwest.com/soap 

Please inquire with the SOAP office 

to place your OB Anesthesia 

job offerings on the SOAP website. 

Email: soaphq@soap.org

Make plans to attend the SOAP 39th 

Annual Meeting in Banff. 

Banff is truly a 

breathtaking location. 

Visit the hotel web site to view 

the slideshow and the hotel 

recreational activities. 

http://www.fairmont.com/banffsprings/ 

• Bowling Center – Canadian 5-pin bowling 

• Pool Area – indoor and outdoor pools, 

whirlpool, children’s wading pool. 

• Mountain Biking – various tours available 

depending on your stamina - remember to 

bring your camera and binoculars. 

• Water Sports – canoeing, boat tours, boat 

rentals, chartered fishing trips, river float 

trips, whitewater rafting 

• Tennis – five supreme turf courts available 

• Coach Tours – four-hour bus tour of 

Banff to Lake Louise with stops along the 

way, Gondola rides atop Lake Sulphur, 

coach/boat combination tours, 

mountain/lake/waterfall tour 

• Horseback Riding – western-style trail rides 

depart from the Fairmont Banff Springs 

Corral (one and three-hour rides available) 

• Hiking - nature walks 

• Lake Louise Panorama Gondola - one 

hour west of Banff - spectacular views of 

Bow Valley from atop Lake Louise ski hill. 

Gondola ride available to Whitehorn Lodge 

Banff Surrounding Attractions: 

• Lake Louise 

• Johnston Canyon 

• Castle Mountain 

• Tunnel Mountain 

• Valley of the Ten Peaks 

• Mount Rundle, Vermillion Lake 

TOUR PACKAGE INFORMATION 

http://www.roadwest.com/soap 

Airport Transportation to and from 

Calgary International Airport to the 

Fairmont Banff Springs Hotel (round 

trip $60.00 USD) – info available at 

http://www.soap.org/meetings.htm 

SOAP Membership Committee Report 

SOAP is blessed with a remarkable membership. Annual meetings are a time not only 

to find out what’s new in obstetric anesthesia, but to catch up with colleagues and 

friends. The Membership Committee is dedicated to pursue the issues that will improve 

and nurture our society. 

In the summer edition of our newsletter, Mike Smith wrote a summary of our 

membership survey. The majority of members were very satisfied with the 

organization. However, there was a relative paucity in “young” members. The 

Membership Committee decided its first priority to address the relatively low number 

of young and new graduate members. While there may be several factors hypothesized 

that may contribute to this discrepancy in SOAP, there was unanimous agreement that 

anesthesia residents should play a prominent role within our organization. 

The Membership Committee proposed an Ad hoc Residents Committee, which was 

approved by the Board of Directors. Dr. Joanne Hudson was elected chair and given 

the charge to organize the resident component of the Society. The mission of her 

committee is to promote resident interest in SOAP with the ultimate goal of retention 

of members in life and promotion of advanced training in obstetric anesthesia. Dr. 

Hudson is very dedicated to the cause and I believe there will be a substantial increase 

in resident members at SOAP. At the Annual Meeting we will identify residents with a 

designated name tag so that all members can make them feel welcome and included. 

The Membership Committee’s next goal was to identify resources which could be used 

to help and support SOAPers in their everyday practice. There was a wide range of 

requests from web based promotions; e.g. web blogs, bulletin boards, interesting case 

log, to more specific member benefits such as a journal. As with all requests financial 

considerations need to be assessed. Currently, the requests are being evaluated on a 

value for money basis. The membership committee members welcome your thoughts 

and ideas, either in person at Banff or via email vasdev.gurinder@mayo.edu. 

2006 has been a challenging year for funding for all physicians. For example, funding 

from the NIH has become increasingly difficult to obtain, with seasoned 

anesthesiologists either not receiving funding or requiring several revisions to achieve 

this goal. Looking at the NIH CRISP database for December 2006, there is a significant 

decrease in NIH funded studies for obstetrics and anesthesia. This may be a reflection 

of the research funding focused on basic sciences and genomics. FAER and OAPEF 

have supported obstetric anesthesia research and have provided starting and supporting 

grants for many. However, with the NIH decrease in funding, a rather discouraging 

environment for long-term academic support has been created. SOAP advocates 

excellence in research, and for those academics who will endure the hard times, I hope 

that SOAP will explore ways of supporting research until new funding opportunities 

arise. Attrition of seasoned investigators takes a considerable time to replace and 

obstetric anesthesiologists run the risk of loosing new innovative ideas that will 

enhance patient care and safety. 

Sadly, my term as Chair of the Membership Committee comes to an end in 2007. 

SOAP Bylaws require the President to select the new committee chair. To avoid any 

conflict of interest, I have asked David Wlody to review potential candidates and make 

a recommendation at the next board meeting. I have enjoyed my time as chair and look 

forward to supporting the next chair enthusiastically. 

Gurinder M. Vasdev, MD 

Chair, Membership Committee 

SOAP 

— 10 —

SOAP Media Award 

The Publications Committee is soliciting nominations 

for the SOAP Media Award. The award will be given 

to a piece from the print or broadcast media that best 

represents the specialty of obstetric anesthesia to the 

general public. This award will be presented at the 

Annual Meeting. Please send your nominations via 

email to soaphq@soap.org. 

ASA/SOAP Abstract Submission 

The deadline to submit your abstracts for the ASA and SOAP Jointly 

Sponsored ASA 2007 Abstract Session is April 2, 2007. 

Additional information available at: http://www.call4abstracts.com/asa 

Distinguished Service Award 

Nominations for the 2008 Distinguished Service Award 

are being solicited by the SOAP Board of Directors. The 

Board selects the recipient(s) based on the following 

criteria: 

• Has been a long-standing Society member 

• Has made numerous contributions to the Society 

(i.e., served on the BOD, presented at Annual 

Meetings, served on Society committees) 

• Has provided exceptional service to the OB 

anesthesia specialty 

Nominations should be sent to soaphq@soap.org. The 

Board of Directors will select a recipient(s) during the 

next Board Meeting in Banff, Canada. 

Past Recipients: 

2000 - Gertie Marx 2003 - Brett Gutsche 

2001 - Mieczyslaw Finster 2004 - Sheila Cohen 

2002 - Robert Bauer 2005 - Frederick Zuspan 

Richard Clark, 2006 - Felicity Reynolds 

James Elam 2007 - Frank James 

James Evans 

Robert Hustead 

and Bradley Smith 

Miscellaneous Items 

— 11 — 

Use of SOAP Mailing List for 

Surveys/Research 

Because of an increasing number of requests for the SOAP 

mailing list, the Board of Directors has established a 

protocol for requesting the official mailing list. As a 

benefit of SOAP membership, those conducting surveys 

or research studies may request the SOAP mailing list. 

Requirements are: 

1. Offered to SOAP Members in good standing. 

2. Mailing list for research use only. 

3. The research survey must be IRB approved at the 

primary investigator's institution. 

4. The survey and IRB approval letter must be 

submitted to SOAP Headquarters. 

5. The survey will then be reviewed by the SOAP 

Research Committee. 

A fee of $100 will be charged for this one-time 

distribution/use of the mailing list. Requests for followup 

surveys will be handled on a case-by-case basis. 

(Note: No email addresses will be provided but, if 

preferred, the survey can be emailed from SOAP 

headquarters.) 

For additional information contact: 

Robert D’Angelo, MD 

Chair, SOAP Research Committee 

rdangelo@wfubmc.edu 

or 

Submit your request to: 

Via Email: soaphq@soap.org 

Via Fax: 216-642-1127 

Via Mail: SOAP 

2 Summit Park Drive, Suite 140 

Cleveland, OH 44131


2006-2007 Board of Directors 

President 


New York, NY 

President-Elect 

Gurinder M. S. Vasdev, MD 

Rochester, MN 

First Vice President 

Linda S. Polley, MD 

Ann Arbor, MI 

Second Vice President 

Lawrence C. Tsen, MD 

Boston, MA 

Treasurer 

McCallum R. Hoyt, MD, MBA 

Greene, ME 

Secretary 

Brenda Bucklin, MD 

Denver, CO 


2 Summit Park Drive, Suite 140 

Cleveland, Ohio 44131 

Immediate Past President & 

Journal Liaison 

William R. Camann, MD 

Boston, MA 

Chair, ASA Committee on 

Obstetric Anesthesia 

Samuel Hughes, MD 

San Francisco, CA 

Newsletter & Website Editor 

Michael P. Smith, MD, MS Ed. 

Cleveland, OH 

Meeting Hosts 2006 

David J. Birnbach, MD 

Miami, FL 

Jose Carvalho, MD, PhD, FRCPC 

Toronto, ON, Canada 

Meeting Host 2007 

Raouf Wahba, MD, FRCPC 

Calgary, AB, Canada 

— 12 — 

Meeting Host 2008 

Barbara Scavone, MD 

Chicago, IL 

Director at Large 

Rakesh B. Vadhera, MD, FRCA, 

FFARCSI 

Galveston, TX 

Representative, 

ASA House of Delegates 

Andrew P. Harris, MD, MHS 

Baltimore, MD 

ASA Alternate Delegate 

Richard N. Wissler, MD, PhD 

Rochester, NY

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