Case Review Form

Anesthesiology Clerkship Week 1

Complete one per week
Students Name

Date

Please fill out this form on one case in which you are involved each week you are
assigned to the operating room. Ask your assigned resident/attending to help select
the case and answer the questions. Residents: please pick an interesting case
which will bring up important issues, if you dont have any, then feel free to make
one up!
Operative procedure/Indication:

Anesthetic considerations for the surgical procedure: what special things occur during this
operation (position?, lots of blood loss?, special concerns like air embolism, need to awaken rapidly,
etc)

Anesthetic considerations for the patients medical condition: comment on the patients
current status and how any problems will impact the anesthetic (diabetes hold pm insulin, monitor
chemsticks), please include management of any medications (take vs hold preoperatively)

Anesthetic plan and reasoning behind it:

e.g., what induction technique (drug class, purpose of each drug); maintenance
technique; why ? What other options are there?

PACU Course: describe course (emesis? VAS pain scores, duration)

PACU Medications
Post-op Check (day after surgery):
Last memory before surgery?

Overall experience?

Pain?

Medications?

Case Review Form

Anesthesiology Clerkship Week 2
Complete one per week
Students Name

Date

Please fill out this form on one case in which you are involved each week you are
assigned to the operating room. Ask your assigned resident/attending to help select
the case and answer the questions. Residents: please pick an interesting case
which will bring up important issues, if you dont have any, then feel free to make
one up!
Operative procedure/Indication:

Anesthetic considerations for the surgical procedure: what special things occur during this
operation (position?, lots of blood loss?, special concerns like air embolism, need to awaken rapidly,
etc)

Anesthetic considerations for the patients medical condition: comment on the patients
current status and how any problems will impact the anesthetic (diabetes hold pm insulin, monitor
chemsticks), please include management of any medications (take vs hold preoperatively)

Anesthetic plan and reasoning behind it:

e.g., what induction technique (drug class, purpose of each drug); maintenance
technique; why ? What other options are there?

PACU Course: describe course (emesis? VAS pain scores, duration)

PACU Medications
Post-op Check (day after surgery):
Last memory before surgery?

Overall experience?

Pain?

Medications?