Opinion ID: 1359764
Heading Depth: 1
Heading Rank: 3

Heading: dr west testified as follows

Text: However, if we put in a solution which is heavier than the relative weight of the spinal fluid solution, the spinal fluid, if it is heavier than that, it will tend, by gravity alone, to go downward. Now, in this technique, one of the three items which is used in a solution of 10 per cent glucose, which increases the relative weight of the injected solution in relation to the spinal fluid, so that we are taking advantage of what we know to cause this solution to go down. Now, in addition to that, the table upon which the patient is located is placed in a slightly tilted position so that we take advantage not only of the fact that the solution is heavier than the spinal fluid into which it is placed, but we also by the position of the table take advantage of this heavier solution, so that, once the solution is put into the subarachnoid space, it goes down. Q.... Now, Doctor, ordinarily, when you are doing a spinal anesthetic, you like to insert the needle below this point here [indicating on Pl. Ex. 5] and I am pointing to the very tip of the conus medullaris; is that correct? A. Ordinarily, yes. Q. And the reason for that is that you want to run no risk of running into the cord proper; isn't that correct? A. It is a matter of some safety, yes.... Q. If you enter opposite L-2, for example, you are below the cord? A. Yes. Q. If you enter opposite L-1, the cord is there? A. The cord is still present, yes.... Q. All right. Let's go to, say, T-12. What do you say about if you enter the spinal canal in the interspace between L-1 and T-12. Would you point that out on the map [Pl. Ex. 5], the interspace between lumbar one and thoracic 12? ... A. Into this space (indicating). Q. Now, is there any danger there of coming in contact with the spinal cord? A. Yes. Q. Isn't it for that reason that whenever you insert a needle in the spinal canal you try to stay below L-1? A. Yes. Q. Why is it that you do not want to strike the cord with your needle? A. Well, for the same reason that I have no desire to strike any nerve with a needle, specifically. Q. What is that reason? A. It may damage the nerve. In answer to the question: Would trauma to the cord cause paralysis? Dr. West answered Yes. In answer to the question: Trauma to the cord or to the nerve roots below the conus medullaris would cause paralysis, would it not? Dr. West answered: It is impossible to cause trauma to the cord below the conus medullaris. Dr. West testified as follows concerning his customary procedure in giving a spinal anesthetic: That when he first went into the delivery room, he told the nurse to turn the patient over on her right side; that he then opened his anesthetic tray; that he then put on sterile gloves; that there were four ampules of drugs on his tray  one of procaine, one of pontocaine solution, one of glucose solution, and one of ephedrine solution; that he opened three of the ampules with a file across the narrow neck of each; that he then drew a solution from each of three ampules into a syringe; that he then drew a solution from the fourth ampule into a smaller syringe; that he next applied a sterile solution to the patient's back; that he then placed a sterile drape sheet over the area just painted with the sterile solution; that I then palpate the bony prominences for my landmarks; that I place my left hand on the patient's upper iliac crest [upper border of the hipbone].... Then I drop my hand from this palpated bony crest into the midline of the back.... I [then] find that at this particular point my thumb is either in contact with the spinous process of lumbar 4 or has actually fallen into the interspace between lumbar 4 and 5.... At the space that I have located, keeping my thumb in the interspace, I raise a skin wheal.... The purpose of that is to alleviate any discomfort on the part of the patient when the subsequent injection is made.... My skin wheal is now made. With my thumb still on this interspace, I pick up my spinal needle and make my approach to the dura. Dr. West then testified that the needle was hollow, that it had a stilet in it to keep it closed; that after the subarachnoid space had been entered, the stilet was withdrawn; that then the syringe was attached to the needle; that then the free flow of spinal fluid from the needle was observed; that he then pick[ed] up my syringe, which has at this moment a total volume of 3 cc's in it. I dispose of 2 cc's of the fluid leaving 1 cc of volume in the syringe; that he then attach[ed] it to the hub of the needle and withdraw [sic] 1 cc of spinal fluid into the syringe; that the syringe is then swirled to mix it, and the drug with spinal fluid in it is injected into the canal; that the needle was then withdrawn and the anesthetic finished. [1] A motion for nonsuit may properly be granted `... when, and only when, disregarding conflicting evidence, and giving to plaintiff's evidence all the value to which it is legally entitled, indulging in every legitimate inference which may be drawn from that evidence, the result is a determination that there is no evidence of sufficient substantiality to support a verdict in favor of the plaintiff.' ( Card v. Boms, 210 Cal. 200, 202 [291 P. 190]; see also Blumberg v. M. & T. Inc., 34 Cal.2d 226, 229 [209 P.2d 1]; Golceff v. Sugarman, 36 Cal.2d 152, 153 [222 P.2d 665].) [2] `Unless it can be said as a matter of law, that ... no other reasonable conclusion is legally deducible from the evidence, and that any other holding would be so lacking in evidentiary support that a reviewing court would be impelled to reverse it upon appeal, or the trial court to set it aside as a matter of law, the trial court is not justified in taking the case from the jury.' ( Estate of Lances, 216 Cal. 397, 400 [14 P.2d 768]; see also Raber v. Tumin, 36 Cal.2d 654, 656 [226 P.2d 574].) (Emphasis added; Palmquist v. Mercer, 43 Cal.2d 92, 95 [272 P.2d 26]; Warner v. Santa Catalina Island Co., 44 Cal.2d 310 [282 P.2d 12].)