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Procedure (s)
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Surgeon
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Anesthesiologist
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Anesthesia start time
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Anesthesia stop time
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Procedure start time
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Procedure stop time
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Pertinent Medical History
• • •
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Preoperative medication list
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ASA Classification
• • •
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Monitors and Equipment used:
• • •
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General Anesthesia Specifics
• • •
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Regional Anesthesia Specifics
• • •
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Monitored Anesthesia Care local used?
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IV gauge(s), location (s)
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Patient position
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Airway Management Specifics
• • •
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Number of intubation attempts.
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Breath Sounds - all sites appreciated
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Anesthesia Complications
• • •
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Vitals and Meds Graph
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