Date :
Anaesthesia & recovery record Sheet no .: Name :
History : Temperament :
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ASA classification
|
Owner :
Patient ID : Species : Breed :
Age : Sex : Weight :
|
Clinical findings / results / medications : |
HR : RR : Pulse quality : MM : CRT : Thoracic auscultation : |
I No organic disease
II Mild systemic disease
III
IV
V
Severe systemic disease ( not incapacitating )
Severe disease ( constant threat to life )
Moribund ( life expectancy < 24 h )
|
Anaesthetist : Clinician : |
Temperature : |
° C |
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 :
� system : 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
Time Heart rate Resp . rate MM & CRT
Temp . Pain score
Other
Monitoring during recovery T + 0 T + 15 T + 30 T + 45
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Appendix 1 . AVA ' s ASA high-risk-anaesthetic monitoring chart [ 10 ] – page 1 of 2 .
32 Veterinary Nursing Journal