of DATE: 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 VAPORIZER SETTING AGENT: DESFLURANE ISOFLURANE SEVOFLURANE HALOTHANE PULSE ● RESP O ET CO2 ▲ SP O2 ■ BLOOD PRESSURE SYSTOLIC v MEAN † DIASTOLIC ^ DIRECT INDIRECT DOPPLER TIMES: TOTAL ANES: PROCEDURE: EXTUBATION: STERNAL: STANDING: AIRWAY MAINTENANCE ET TUBE MASK SIZE: SYSTEM: CIRCLE NON-REBREATHING MECH VENT CATHETER: SIZE: TYPE: LOCATION: SIZE: TYPE: LOCATION: Post-Op TPR REMARKS POST-OP AGENTS: SYMBOLS 180 160 PAGE ANESTHETIC 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