ofDATE: SURGEON: ANESTHETIST: CLIENT #:

PROCEDURE: POSITION: ASA PATIENT NAME:` STATUS

BODY WT: TEMP: PULSE: RESP: PCV: TPP: MM/CRT: SPECIES: BREED:

OTHER PE or LAB: FACILITY:

PRE-ANESTHETIC AGENT(s) INDUCTION AGENT(s)AGENT DOSE(MG) ROUTE TIME AGENT DOSE(MG) ROUTE TIME

TIME: :1 5 :3 0 :4 5 :1 5 :3 0 :4 5 :1 5 :3 0 :4 5 :1 5 :3 0 :4 5 TOTALS

IV 1:TYPE:RATE:

IV 2:TYPE:RATE:

Bair Hugger

Circ. Water Blanket

OXYGEN L/min

VAPORIZERSETTING

AGENT: DESFLURANE ISOFLURANE SEVOFLURANE HALOTHANE

PULSE ● RESP OET CO2▲ SP O2 ■BLOOD PRESSURE

SYSTOLIC vMEAN †DIASTOLIC ^

DIRECT INDIRECT DOPPLER TIMES:

TOTAL ANES:

PROCEDURE:

EXTUBATION:

STERNAL:

STANDING:

AIRWAY MAINTENANCE

ET TUBE MASKSIZE:

SYSTEM: CIRCLE NON-REBREATHING MECH VENT

CATHETER:

SIZE:

TYPE:

LOCATION:

SIZE:

TYPE:

LOCATION:

Post-OpTPR

REMARKS

POST-OP AGENTS:

SYMBOLS 180

160

PAGEANESTHETIC RECORD

180

160

100 100

140

110

120

140

120

110

90

80 80

50

90

40

70 70

60 60

50

40

30

20 20

10 10

30

TIME