If a positioning-related injury occurs, who bears responsibility?

• A. You (the anesthesia provider)
• B. The surgeon
• C. The patient
• D. The hospital

Answer: (A)

Positioning during anesthesia is under the anesthesia provider’s control, and preventing injuries from malposition is a key safety responsibility during the case. Once the patient is under anesthesia, they cannot feel or report uncomfortable pressures, so it’s up to you to ensure proper alignment, padding, and protection of nerves, eyes, and soft tissues throughout the procedure. This means arranging limbs to avoid nerve entrapment, using appropriate supports and padding, maintaining neutral joints, and reassessing positioning if the duration is long or the patient’s risk factors (like obesity, diabetes, or preexisting neuropathies) raise the risk of injury. If a positioning-related injury occurs, it generally points to a lapse in that intraoperative protection and monitoring by the anesthesia team, making you the responsible party. The surgeon contributes to overall safety by ensuring good exposure and technique, and the hospital provides equipment and policies, but the direct duty to prevent positional injuries during anesthesia lies with the anesthesia provider.