Anesthesia Record of Clinical events

ANESTHESIA RECORD

Date: Patient Surgeon(s)

START STOP

OR No. Procedure(s)

Page ___of___ PATIENT INFORMATION ANESTHESIA

PRE-PROCEDURE Age Sex Ht Wt MONITORS & EQUIPMENT ANESTHETIC TECHNIQUE

PROCEDURE

 Pt Identified  Chart Reviewed  Stethoscope:  Precordial GENERAL:  Intravenous

B/P P R T  Esophogeal  Other  Inhalation  Intramuscular AIRWAY MANAGEMENT

 Consent  NPO since

Signed ___________  Noninvasive B/P:  L  R  Pre-Oxygenation  LTA INTUBATION:  Oral  Nasal

Pre-Anesthesia State:  Calm Allergies  Continuous EKG  Temp______  Rapid Sequence  Rectal  Direct  Stylet Used  Blind

 Awake  Asleep  Pulse Oximeter  NG / OG Tube  Cricoid Pressure  Tube & Size__________________

Medications

 Apprehensive  Confused  End Tidal CO2  Fluid Warmer REGIONAL:  Spinal  Blade _____________  Laser

 Uncooperative  Unresponsive  V Lead EKG  Gas Analyzer  Epidural  Axillary Attempts x ____ Secured at ____cm

PATIENT SAFETY Positive Hx/Med. Problems  Nerve Stimulator  Bier Block  Ankle Block  Breath Sounds _______________

 Anesthesia machine checked  Foley Catheter  Position________________  Uncuffed, leaks at _____cm H2O

 Pressure points checked & padded  Airway Humidifier  Local__________________  Cuffed  Min. occlusive pressure

 Safety Belt On  Axillary roll  IV(s) ______________________  Drug(s)________________ AIRWAY:  Oral  Nasal

 Arms tucked  Restraints ASA 1 2 3 4 E