Anesthesiology Expert Witness Explains Intraoperative Positioning

This case involves a forty-five-year-old female patient who underwent a total knee replacement procedure and sustained significant complications immediately following surgery that were unrelated to the surgical site. The patient complained of bilateral hand numbness in the postoperative recovery room. The patient received a diagnosis of bilateral cubital tunnel syndrome and the medical records suggested that the injury was likely from improper intraoperative positioning. The disability was acute onset after the procedure and, subsequently, the patient displayed wasting of the hand muscles, finger weakness, and persistent ulnar edge paresthesias.

Question(s) For Expert Witness

1. What is the standard of care and who is responsible for positioning patients during long surgical procedures?

Expert Witness Response

All perioperative team members are responsible for the safe positioning of surgical patients. Circulating nurses coordinate the positioning of patients during intraoperative periods of care. Skilled perioperative nursing interventions afford patients safe and comfortable positioning during surgery, ensure optimal exposure of surgical sites, and prevention of postoperative complications (e.g., pressure injuries, neuropathies, cardiovascular and respiratory compromises). Perioperative nurses should have a working knowledge of anatomy and physiology, patient risk factors, injury mechanisms, potential complications, and positioning devices before placing patients in required perioperative positions.