Anesthesia Record.docx

ANESTHESIA RECORD Case No: Last Name:

OR Suite No. First Name AGE

PREOPERATIVE FINDINGS: BP PR RR

SEX

STATUS

Date: MI HEIGHT

WEIGHT

HEMATOCRIT

HEMOGLOBIN

BLOOD TYPE

PREOPERATIVE DIAGNOSIS TEMP

CARDIOVASCULAR RESPIRATORY CENTRAL NERVOUS SYSTEM ENDOCRINE PREVIOUS ANESTHETIC EXPERIENCE ALLERGIES LAST MEAL

OPERATION PROPOSED: PRE MEDICATION

POSITION

CONSENT DOSE

RISK

ROUTE

1

2

HOURS

TIME

3 4 TOTAL FLUIDS GIVEN

AGENTS 0XYGEN L/MIN

TOTAL BLOOD GIVEN

FLUIDS

URINE OUTPUT

BLOOD

X ANESTHESIA STARTED

PULSE RESP TEMP CVP SYST BP

180 180 140 120 100

5

X OPERATION STARTED X OPERATION ENDED MAINTENANCE

80 DIAS BP

60 ANESTHETIC AGENT 40 20

SYMBOLS DETAILED TECHNIQUE

CONDITION OF PATIENT ON DEPARTURE FROM OR

( ) TO MAIN WARD/ICU ( ) TO RECOVERY ROOM

GOOD FAIR POOR GUARDED OROTRACHEAL _______ NASOTRACHEAL _______ CUFF _______ UNDER MASK _______ BLIND _______ NASOPHARYNGEAL AIRWAY _______ RECOVERY REFLEX IN OR YES __ NO __ RETCH ___ RES OBS TR. EMESIS _____ PUL VENT ____ EXCIT M.S.T.O.F. _______ HEAD LIFT _______ OPERATION: __________________________________________________________________________________________________________ POATOPERATIVE DIAGNOSIS: _____________________________________________________________________________________________ SURGEON: ________________________________________ NURSES: _________________________________________________ ASSISTANT: _______________________________________ SIGNATURE OF ANESTHESIOLOGIST: ___________________________