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Anaesthesia Records

Date: Time: Name: Diagnosis: Operating Surgeon: Anesthetist: Pre-Operative Check-up History: Examination: GeneralPallor: Cyanosis: Clubbing: M.P.C. Grade: Mouth Opening: o Respiratory System: Air Entry: o Cardiovascular System: Heart Sounds: o Neurological Status: Higher Functions: Motor: Sensory: Bladder/ Bowel: Investigations: o o o o o o HbT.L.C.BUN: Sr. Creat: A.S.T.: A.L.T. F.B.S: P.L.B.S: C.X.R.: Special Investigations: E: M: P: Na: K: Cl: Bili. Total: Direct: HIV: HBSAg: E.C.G.: L: IPD no: Age/Sex: Operation/ Procedure: Wt:

Icterus: Tooth:

Oedema: Neck movements: Added Sounds: Murmurs:

A.S.A. Grading: I / II/ III/ IV / V / E Informed Consent: Starvation: Anaesthesia Technique: I.V. Lines: Monitoring: SPO2/BP/ ECG/ EtCO2/ Temp Anaesthesia: GA/ SA/ Epidural / Regional Block / TIVA / LA Position: Pre-medication:

Regional Anaesthesia: o Type: Subarachnoid / Epidural / Brachial Plexus / o Level: Needle: Approach: o Drug: Batch No.: o Level Achieved: General Anaesthesia: Induction: Intubation: Maintenance:

o o o

0Hr 200 180 160 140 120 100 80 60 40 20 0 o Reversal: o Extubation:

1Hr

2Hr

3Hr

4Hr

5Hr

Post- Operative: Pulse: / min B.P.: / mm of Hg R.R.: /min Level: % SpO2: Head Lift: Responds to: o Advice:

Level:

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