A-693 Pharmacogenetic effect of b 2 AR genotype on preterm labor and response to tocolysis: a systematic review L. Stephenson 1 , R. Smiley 1 , M. Wood 1 , R. Landau 1,2 1 Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY, USA; 2 Department of Anesthesiology, University Hospital of Geneva, Switzerland Background and Goal of Study: The b 2 -adrenergic receptor (b 2 AR) dis- plays genetic variability with several single nucleotide polymorphisms (SNPs). At codon 16 (Arg16Gly), the Arg allele is associated with decreased down-regulation of the b 2 AR; at codon 27 (Gln27Glu), the Glu allele decreases desensitization and down-regulation 1 . Since the b 2 AR is expressed in uter- ine muscle and is a target for tocolytic agents, it has been postulated that SNPs of b 2 AR could alter the course of preterm labor (PTL) and delivery (PTD). The goal of this systematic review of the literature was to analyze the current evidence regarding the b 2 AR genotype as it pertains to PTL and PTD. Materials and Methods: We searched MEDLINE (1966 to 2005) using the following search terms: preterm labor, pregnancy, tocolysis, b 2 adrenergic receptor, polymorphism, genetic. We found 4 studies assessing the effect of b 2 AR genotype on outcome of PTL: 3 case-control studies 3–5 and one prospective cohort treatment trial with b 2 -agonists for tocolysis 2 . Results and Discussions: In all four studies, b 2 AR genotype affected the course of PTL. In the study assessing the response to tocolysis 2 , neonatal outcomes were also significantly altered by genotype (Table). References n SNP/variant Outcome p Landau 2005 2 60 Arg16 ↑ gestational age 0.04 ↑ birth weight 0.036 Doh 2004 3 32 Arg16 ↓ PTD 0.002 Ozkur 2002 4 80 Glu27 ↑ PTL 0.001 Landau 2002 5 28 Arg16 ↓ PTD 0.01 n = # patients with PTL. Conclusions: Arg16 homozygosity had a protective effect on the occurrence of PTD and improved neonatal outcomes while the Glu27 variant was asso- ciated with an increased incidence of PTL. This is the first review assessing the pharmacogenetic effect of b 2 AR genotype on PTL. Further trials using such tocolytic therapy or b 2 –agonists for other indications (ephedrine for treat- ment of hypotension) should control for receptor genotype. References: 1 Liggett S. N Engl J Med 2002; 346: 536–8. 2 Landau R. Clin Pharm Ther 2005; 78(6): 656–63. 3 Doh K. J Perinat Med 2004; 32: 413–7. 4 Ozkur M. Int J Gynecol Obstet 2002; 77: 209–15. 5 Landau R. Am J Obstet Gynecol 2002; 187(5): 1294–8. A-694 Survey of methods used to ensure asepsis whilst performing regional anaesthesia and analgesia in obstetrics M. Naik 1 , C. Mannakkara 2 , N. Aravindhan 3 1,2,3 Department of Anaesthesia, Whipps Cross University Hospital, London Background and Goal of Study: Asepsis and sterile precautions prior to regional techniques are vital to avoid serious neuroaxial infections. The Royal College of Anaesthetists publication (2004) offer some guidance regarding aseptic technique for continuous epidural infusions. We decided to conduct a postal survey of obstetric anaesthetists to establish what they believed to be the necessary minimal essential sterile precautions. Materials and Methods: Questionnaires that looked at commonly used aseptic techniques and variations, were sent to all college tutors in hospitals in the North London region. We requested that these were distributed to all anaesthetists practising obstetric anaesthesia. Results and Discussions: 84 (29%) anaesthetists responded. Only 36% (n = 31) were aware of local guidelines which set standards for asepsis. We defined strict aseptic technique as full scrub (similar to that of surgeons), wear- ing hat, gown, mask and sterile gloves. 60% (n = 50) adopted these precau- tions for spinal anaesthesia and 44% (n = 37) for epidural analgesia. % of responders ATTIRE WORN Spinal Epidural Gown/gloves/hat/mask 73.8 (n = 62) 58 (n = 49) Gown/gloves/hat 21.4 (n = 18) 20.2 (n = 17) Gown/gloves/mask 1.2 (n = 1) 6 (n = 5) Gown/mask/hat 2.4 (n = 2) 2.4 (n = 2) Gown/gloves 1.2 (n = 1) 11 (n = 9) Gloves only 2.4 (n = 2) 40% restricted the number of individuals in the room whilst performing the spinal procedure. 23% (n = 19) of respondents performed rapid sequence spinal anaesthesia for emergency caesarean section. 12 complications were noted from this survey these included meningitis (3), epidural abscess (3), local infection (5) and other (1). Conclusions: Most anaesthetists were unaware of guidelines which set standards for aseptic technique. Our survey suggest that are considerable differences in practice in relation to the minimum essential precautions used to ensure sterility for regional anaesthsia and analgesia. There are also vari- ations of technique when performing either spinal and epidural. Reference: Sellors, J et al Anaesthesia 2002 (57) 593–596. A-695 Obstetric anaesthesia practice: Lithuanian survey A. Karbonskiene, L. Pieteris, K. Rimaitis, E. Steponaitiene, B. Petraitiene Clinic of Anaesthesiology, Kaunas University of Medicine Background: Regional anaesthesia and analgesia become prevailing methods in anaesthesia care for obstetric patients. Data concerning obstet- ric anaesthetic practice in Lithuania are lacking. A comparison with figures from other European countries might be of interest. Goal of Study: To investigate the availability and pattern of obstetric anaes- thesia and analgesia services in Lithuania. Materials and Methods: Standard questionnaires on obstetric anaesthesia in 2004 were mailed to all dept. of anaesthesia of hospitals providing obstet- ric care. Results and Discussions: In 2004 there were 49 hospitals providing obstetric care in Lithuania. Responses were received from 32 dept. of anaes- thesia. Responding hospitals had cared for 69.9% of deliveries in the country. Non-pharmacological means of analgesia were available in 96% of hospi- tals. Systemic analgesia was provided in 80% of facilities, obstetricians being responsible for it in 83.3%, anaesthetists – 8.3%, both – 8.3% of hos- pitals. Regional analgesia for labour was possible in 67.7% of facilities, but it was provided only in 8.8% (min.–max. 0–39.8%) of cases. It was per- formed due to medical indications in 7.3% and according to preference of parturient in 92.7% these cases. Mean annual Sectio caesarea (SC) rate was 16.9% (min.–max. 5–27.5%), 6% were scheduled and 10.9% were emer- gency SCs. For scheduled SC general anaesthesia was used in most cases (62%), followed by spinal (29%) and epidural anaesthesia (9%). General anaesthesia was used extensively for emergency deliveries (91%). General anaesthesia with tracheal intubation and controlled ventilation was the only option of general anaesthesia for SC in responding hospitals. Conclusions: Means of non-pharmacologic and systemic analgesia for labour were extensively used in Lithuania in 2004. Methods of regional anal- gesia were available only to a small number of parturients. The use of regional anaesthesia for SC was considerably less common in Lithuania than in Western European countries. A-696 Anesthetic techniques for obstetrics in Catalonia in 2003 S. Sabate 1 , J. Canet 2 , C. Gomar 3 , J. Castillo 4 , A. Villalonga 5 , C. Fernandez 3 , C. Hervas 6 1 Fundacio Puigvert, Barcelona; 2 Hospital Universitari Germans Trias i Pujol, Badalona; 3 Hospital Clinic, Barcelona; 4 Hospital del Mar-Esperança, Barcelona; 5 Hospital Universtari Josep Trueta Goal of Study: Within an extensive epidemiological survey of anaesthetic activity in Catalonia (ANESCAT) we analysed common practice of obstetric analgesia and anaesthesia during 2003. Methods: We conducted a cross-sectional survey that used information reported by anaesthesiologists from all public and private hospitals practis- ing anaesthesia around Catalonia (6,704,146 inhabitants) on 14 randomised days in 2003. We recorded information that included characteristics of patients, anaesthetic techniques and procedure for which anaesthesia was required. We analysed information concerning obstetric activity, calculating what proportion of all anaesthetic activity it represented, the coverage of the entire obstetric population, the rate of caesarean section (CS) and the distri- bution of anaesthetic techniques. Results: In 131 hospitals 23,136 anaesthetic procedures were performed on the 14 days studied. Seventy-one hospitals (54%) performed obstetric procedures, 44 of them public and 27 private. Anaesthesia for obstetrics represented 11.3% of all cases. This extrapolates to 67,864 anaesthetic 180 Obstetric anaesthesia