You are assigned to assist in circulator duties on a procedure requiring spinal anesthesia in your teaching hospital. Your immediate task is to help position the patient for the spinal and help the patient maintain the position while the spinal is administered. The patient states to you that she is afraid, but you reassure her that there will be little discomfort. The anesthesia care provider and anesthesia resident state that the patient should be placed in a side-lying position. The anesthesia procedure begins:
1. The anesthesia care provider tells the resident that he or she should go ahead and perform the procedure. The resident steps forward and applies a cold prep solution to the injection site. The patient flinches and moves out of position. What do you do?
2. The local anesthetic has been injected into the spinal injection site and the resident searches for the correct insertion site for the spinal needle by palpating the intervertebral spaces. The patient asks you quietly if the needle is in yet. What do you reply?
3. Now the resident has made four attempts to enter the subarachnoid space. Fresh spinal needles have been brought into the room for more attempts. The patient is now very uncomfortable and feeling the pain of the repeated insertions of the spinal needle by the resident. Two more attempts are made without success. What should you say to your patient, who is visibly upset and trying to remain still?
4. What, if any, is your dialogue with the resident during these attempts?
5. Finally, after many attempts, the anesthesia care provider takes over and is able to insert the spinal needle at first try. Everyone is relieved. Think carefully about what you would say to the patient at this point.