Different positions are indicated or requested to facilitate various surgical procedures. Optimal positioning allows or improves surgical access without compromising the patient's physiology or injuring soft tissues and skeleton. The patient's limited physiological reserve must be considered carefully, especially the cardiovascular and respiratory systems, abnormalities of the autonomic nervous system and conditions that limit mobility and range of movement. The anaesthetist must take all factors into consideration and achieve a position that minimizes the risk of complications, allows the best possible surgical access and ensures optimal safety with access to the airway, vascular devices and monitoring equipment. Positioning requirements for surgery need to be anticipated by the anaesthetist. The anaesthetist should tailor preoperative assessment to identify potential problems. Theatres should be informed of any special equipment that will be needed. Considerations regarding positioning need to extend into the postoperative period, especially with regional anaesthesia.