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Anesthesia Record Template
Anesthesia Record Template
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Anaesthesia & recovery record Sheet no.:
Pre-GA medication Dose Route Time Induction agent(s) Dose Route Time
Anaesthetic
…………………………………………. ……………….. ……….. ………... ……………………………………….… ……………….. ………... ………...
Safety
……………………………………….… ……………….. ……….. ………... ……………………………………….… ……………….. ……….. ………...
Checklist
……………………………………….… ……………….. ……….. ………... ……………………………………….… ……………….. ……….. ………...
completed
……………………………………….… ……………….. ……….. ………... IV catheter Position: Size:
Extubation time:
Heart rate
Other
post-op Resp. rate
care MM & CRT
Temp.
Relevant information transferred to kennel sheet / patient
Pain score
record
Other
Time Start procedure: Finish procedure:
Total ……………..………ml
Blood volume
Dog
10% 85ml/kg
……………..………ml
Notes
Key 240
230
HR ● 220
RR o 210
200
IPPV ø 190
SAP 180
˅
170
MAP – 160
150
DAP ˄
140
Doppler 130
120
Palpebral reflex
110
Jaw tone 100
90
- / + / ++ / +++ 80
70
Eye position 60
↓/→ 50
40
30
20
10
Iso / Sevo %
Jaw tone
Pulse quality
ETCO2 kPa/mmHg
SpO2 %
Temperature °C