Anesthesia Record Template – Fill Out and Use This PDF

Anesthesia Record Template is one of the best templates to use when it comes to recording patient information. This template makes it easy for you to record even sensitive patient data because no personally identifiable information is required.

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Anesthesia Record Template PDF Details

The anesthesia record template is a word document that can be accessed for free. It includes an easy to follow chart with the date, time, surgery type, and any other pertinent information. The person administering the anesthesia has all of this information in one place to make their job easier. There are many benefits to having this document available before surgery including making sure there is no confusion about what type of surgery will be performed or if it's even necessary at all because you have access to pre-op notes as well as allergies and medications that may need to be addressed before surgery begins.

Below, you'll see a number of information regarding anesthesia record template PDF. It's definitely worth taking a few minutes to learn this before you begin filling out your document.

Question	Answer
Form Name	Anesthesia Record Template
Form Length	2 pages
Fillable?	Yes
Fillable fields	132
Avg. time to fill out	26 min 58 sec
Other names	veterinary anesthesia record template excel, anesthetic record, printable anesthesia record, anesthesia record template excel

12

Form Preview Example

Anaesthesia & recovery record

Date:

Sheet no.:

Click here

to add logo

Name:

History:

Temperament:

ASA classification

Owner:

Patient ID:

HR:RR:

Pulse quality:

INo organic disease

IIMild systemic disease

Species:

Clinical findings/results/medications:

MM:

CRT:

Severe systemic disease

III

(not incapacitating)

Breed:

Age: Sex:

Weight:

Anaesthetist:

Clinician:

Thoracic auscultation:

Temperature:°C

Severe disease

IV

(constant threat to life)

Moribund

V

(life expectancy < 24 h)

Add ‘E’ for emergencies

ASA Grade:

Procedure(s):

Anticipated problems:


Pre-GA medication	Dose	Route Time
………………………………………….	………………..	……….. ………...
……………………………………….…	………………..	……….. ………...
……………………………………….…	………………..	……….. ………...
……………………………………….…	………………..	……….. ………...

ET tube / LMA / Mask		Size:
Cuffed / Uncuffed

Anaesthetic

Safety

Checklist

completed

Eye(s)

lubricated


	Induction agent(s)		Dose	Route	Time
	……………………………………….…		………………..	………...	………...
	……………………………………….…		………………..	………..	………...
	……………………………………….…		………………..	………..	………...
	IV catheter Position:			Size:


	Breathing	Patient position:
	Breathing
	system:	Patient warming:
		Patient warming:

Anaesthesia monitoring record overleaf

Recovery concerns & instructions:

Temperature: °C

Extubation time:

IV catheter

care

Remove once recovered

Maintain & flush

Post-op fluid

therapy

Post-op

analgesia

Other

post-op

care

Relevant information transferred to kennel sheet / patient record

Monitoring during recovery

	T+0	T+15	T+30	T+45
Time
Time
Heart rate
Heart rate
Resp. rate
Resp. rate
MM & CRT
MM & CRT
Temp.
Temp.
Pain score
Pain score
Other
Other

		Time																																				Start procedure:						Finish procedure:
																																						Throat pack				Placed				Removed
		Notes																																				Throat pack				Placed				Removed
																																						<![endif]>volume		Total		……………..………ml					Dog
																																															Dog
																																								10%		……………..………ml				85ml/kg
																																								10%		……………..………ml

																																						<![endif]>Blood		20%		……………..………ml				Cat / Rabbit
																																														Cat / Rabbit
																																								30%		……………..………ml				55ml/kg
																																								30%		……………..………ml
																																						Notes


Key		240
Key		240
		230
HR	●

		220
	o	220
RR		210
RR		210
IPPV	ø	200
		200
		190
		190
SAP	˅	180
SAP	˅	180
MAP	–	170
		170
		160
		160
DAP	˄	150
		150
		140
Doppler		140
		130
		130
		120
Palpebral reflex

		110
Jaw tone		110
		100
		100
- / + / ++ / +++		90
		90
		80
		80
		70
Eye position

		60
		60
↓ / →		50
↓ / →		50
		40


		30
		30
		20
		20
		10
		10

Iso / Sevo		%

O2 / N2O / Air		L/min

Palpebral reflex																																						Swabs							Sharps

Eye position																																						In			Out				In		Out

Jaw tone

Pulse quality

ETCO2		kPa/mmHg

SpO2		%

Temperature		°C

How to Edit Anesthesia Record Template Online for Free

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Step 1: First, pick the orange "Get form now" button.

Step 2: Once you access the anaesthetic chart pdf editing page, you will find all of the actions you can undertake regarding your file in the upper menu.

To be able to prepare the anaesthetic chart pdf PDF, provide the content for all of the segments:

anesthesia record sheet fields to fill out

Note the data in Checklist completed, ………………………………………, Size:, ET tube / LM, A / Mask Cuffed /, Size:, Eye, s lubricated, cid, 70 Breathing, system:, Patient position: Patient warming:, Anaesthesia monitoring record, Recovery concerns & instructions:, Temperature:, Ex, tuba, tion time:, and IV catheter.

Completing anesthesia record sheet step 2

Describe the considerable information about the Other post, op care, cid, 70 Relevant information, record, Heart rate Resp, and Temp box.

anesthesia record sheet Other post-op care, (cid:70) Relevant information, record, Heart rate Resp, and Temp fields to fill out

The Key HR RR I, PPV SAP MAP DAP Doppler, ● o ø ˅ – ˄, Time Notes, % kPa, mmHg % °C, e m u o v d o o B, Notes, Swabs In, Start procedure: cid, 88 Finish, Total ……………, Dog, 85, ml, kg Cat / Rabbit, 55, ml, kg and Sharps In section has to be used to note the rights or obligations of both sides.

stage 4 to filling out anesthesia record sheet

Finish by looking at the next fields and filling them out as required: P, alpe, br, al reflex, Eye position, Jaw tone, Pulse quality, ETC, O, 2 S, pO, 2 Temperature, % kPa, mmHg % °C, Swabs In, Sharps In, Out, and Out.

Palpebral reflex, Eye position, Jaw tone, Pulse quality, ETCO2, SpO2, Temperature, % kPa/mmHg % °C, Swabs In, Sharps In, Out, and Out in anesthesia record sheet

Step 3: Choose the Done button to make certain that your finished file may be transferred to every electronic device you end up picking or sent to an email you specify.

Step 4: It is simpler to have copies of your file. You can be sure that we will not display or view your data.

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