The Case
My OR table almost seriously injured my patient. We had just completed a rotator cuff repair on a healthy 50-year-old man, performed on a Captain’s Table. After dressing the wound, with the patient still in the beach chair position, I extubated him. He was awake but drowsy and breathing on his own. The interscalene block was working well and he had no pain. We rotated the OR table 90 degrees to prepare for transfer to the gurney.
As we locked the OR table, the table back began to slide backward — taking my patient’s torso with it. I quickly grabbed the back support and held it upright, one hand on either side of the patient. Luckily, one of the two horizontal placement struts remained partially in the bed channel. If not, I might not have had the strength to stop it from falling. At this point both my hands were locked in a death grip on the table. Fortunately, my patient was breathing well and was calm.
I yelled for help. The OR team quickly gathered around. Together we worked as a team to figure out how to transfer the patient without injury. The fact that the patient was awake enough to follow simple commands and not struggle helped a great deal. The patient suffered no harm
Upon examining the table, we found that the back of the Captain’s Table had been set but not securely locked. When our RN nurse was setting up the OR table, the OR tech approached him with a last-minute sterilizer problem. Distracted, the RN forgot to lock the fasteners on the back attachment. The grip held during surgery, but the back began to slide off when we jostled the table during the turn.
I had not personally checked the locks beforehand. To be honest, at that time I had never learned how to assemble the Captain’s Table. I had considered that the RN’s job. I now know how to put it together myself.
Introduction
The operating room (OR) table is a central component in surgical procedures. It offers adjustable positioning to improve surgical access. It also ensures patient safety. It’s typically set up by the OR nurse and OR techs. As anesthesia providers, we often focus on operating the table controls once they are set up. These controls include up/down, tilt, the Trendelenburgs, and head tilt. But I usually don’t assemble the specialty parts myself; I rely on my OR team to do so. Still, anyone, even the most skilled team member can forget a step or make a mistake. My failure to check the locking mechanisms in this case nearly led to disaster.
Know Your OR Table Attachments
I have seen an arm board disconnect when a patient first put weight on it. Its latch hadn’t fully caught the rail on the OR table. A head piece once pulled out of its channel when I started to use it to reposition the bed. Each one of these represented a failure to check the locking mechanism.
There are many OR table brands and models. They have a variety of attachments for different surgeries — too many for me to detail here. Have your OR nurse teach you how your OR’s equipment works.
This video shows how to set up an older Steris table, similar to the one that got us into trouble. It emphasizes the importance of ensuring that the back mechanism is locked.
Anesthesia providers need to know how each part of their setup works. Routinely carry out preoperative checks to find problems to protect your patient before they get on the table.
Positioning Safely on the OR Table
Proper positioning on the OR table is crucial. It helps to avoid patient injuries such as nerve damage, pressure ulcers, and circulatory compromise. Anesthesiologists are responsible for monitoring and adjusting the patient’s position before and during surgery.
Metal attachment ridges and rails on OR tables are usually covered by a sheet, hiding them from your view. Anesthesia providers need to be familiar with the table’s controls and features. This knowledge allows them to work effectively with surgeons and nurses to guarantee safe patient alignment. It also allows for rapid adjustments if complications arise. This includes:
- Check pressure points where soft tissue meets any hard surface
- Ensure that the ulnar and popliteal nerves are not resting against metal attachment rails, or leg candy canes. This can occur if the arm is tucked, or the knee is bent and allowed to dangle.
- Make sure limbs and fingers are not in a pinch point at table joints.
Emergency Situations: Know Your OR Table
In emergencies, like cardiac arrest or unexpected patient movement, rapid access to the table’s controls is vital. Anesthesiologists must manage to swiftly adjust the table to give optimal access for resuscitation or airway management. This is relatively simple when the patient is supine and the head is next to you. The controls are less intuitive if the patient is turned 180 degrees from you. This also applies if the patient is in the sitting position or is attached to the operating robot.
Familiarity with these controls in all possible situations prevents delay for critical interventions .
When to Have a Gurney Outside the OR Door
There will be emergencies that need moving the patient to a gurney for resuscitation. You can’t do CPR on a prone patient. You also can’t easily perform it on a patient sitting in a beach chair position. Time will be of the essence. If your patient is in such a position always have a gurney immediately available outside the OR. Check here for other suggestions on dealing with cardiac arrest in the OR.
Airway Management and Access
Many surgical procedures need specific table positions which can significantly affect airway access and ventilation. Anesthesiologists must predict and respond to these changes to keep the airway open and give adequate oxygenation.
Understanding how to use the OR table empowers anesthesiologists to improve patient positioning for safe intubation, ventilation, and emergency interventions. This is especially true for surgeries requiring special table attachments like the Captain’s Table for beach chair position.
Intubating in the beach chair position is awkward, especially if the patient is obese or otherwise has a difficult airway. Anticipate problems with positioning ahead of time. Tilting the whole “beach chair” toward Trendelenburg is helpful, especially for a short intubator like myself. I also stand on a step-up. Don’t hesitate to strategically place extra pillows under the patient. You can remove them once the airway is secure. Consider having a video-laryngoscope available for either backup or primary use.
Some providers use Laryngeal Mask Airways for selected shoulder surgeries in the beach chair position. Because access to the head and face is markedly restricted, choose your patients wisely. Devise a method to reposition the chair safely. Make sure you have a plan to reach the airway if it becomes blocked. You must be capable of doing this while avoiding disruption to the surgery or contamination of the sterile field. Play with the controls ahead of time and know them intimately.
For background on opening the airway and positioning for intubation see:
Facilitating Surgical Workflow
Efficient use of the OR table contributes to seamless surgical workflow. Anesthesiologists who are knowledgeable about table mechanics can quickly respond to requests for repositioning, enhancing communication and reducing procedure time. This not only improves operational efficiency but also minimizes anesthesia exposure and related risks for the patient.
For example, in robotic surgery, understanding OR table controls is crucial for patient safety. The robot and table must move as one to prevent injury.
Integration with Monitoring Equipment
The OR table is often integrated with various monitoring and support devices. Anesthesiologists must understand how table adjustments affect the device placement. They must also realize how these adjustments impact the function of devices. These devices include intravenous lines, monitoring leads, and ventilation equipment. You can and will pull out lines if you ignore the table and its attachments during moves.
Communicate With Your Surgeon
Before moving any controls on the OR table talk to your surgeon first. Indeed, check what’s going on during the surgery before going under drapes and bumping the OR table. Even tiny unexpected OR table bumps at the wrong time can cause major problems to a surgeon wielding a scalpel.
Conclusion
Anesthesiologists’ skill in how the OR table works is integral to patient safety. It also plays a crucial role in effective airway management, efficient surgical procedures, and rapid response in emergencies. Continuous education is essential for anesthesiologists. They need hands-on familiarity with OR table features to fulfill their responsibilities. These are crucial for contributing to successful surgical outcomes. Ask your OR RNs and techs to show you the important safety steps. Trust but always verify.
As a patient and old retired lawyer, you never cease to amaze! I have learned more from your posts than anywhere, and now know what to ask regarding anesthesia. (Last surgery, June 2025) Any student or colleague working with you should be grateful. A million thanks!