Date: Asst.

Prof:

Operation theatre:

Patient’s Name:
Height:
Age/Sex:

Weight:

IP No:
BMI:

Diagnosis:

Procedure:

Anaesthetic plan:

ASA/PS
 PREOPERATIVE ASSESSMENT

Medical Illness:

Surgical History:

General examination:

Systemic examination:

Vitals: Airway assessment:

Pulse rate - Mouth opening -

Blood pressure - MPC -
SPO2 - Dentition -
Respiratory rate - Neck movements -
CVS –
RS - Spine -

INVESTIGATIONS:

CBC- , Urea - , Cr - , BT/CT- ,

Sugar - , LFT - , Serum electrolytes ,PFT- ,

ECG - , CXR - , ECHO - ,Viral markers- ,

Specialist opinion:

Assessed under ASAPS:

Preoperative advice:

NPO timing:

Medications to avoid prior to surgery:

Medication to continue on the day of surgery:

 INTRAOPERATIVE FLUIDS

*Crystalloids-Ringer lactate0.9%

Normal saline-

Dextrose Normal saline-

*Colloids- Hydroxy ethyl starch

Others-

Intraoperative Blood & Blood products-

*Packed red blood cells-

*Whole blood

*Fresh frozen plasma-

*Platelets-

*Cryoprecipitates Product

Bag number-

Date of collection-

Date of Expiry-

Transfusion start time-

Transfusion end time

Duration of transfusion

Transfusion reaction,if any-

Treatment given
 UNIVERSAL PRECAUTIONS

1. Care of skin

2. Hand washing

Before procedure:

After procedure :

3. Protective barrier

Gloves :

Mask :

Eye protection :

Cap :

Plastic apron :

Shoes :

4. Handling of sharp items:

5. Disposal of sharp items:

6. Management of spillage:

Blood :

Body fluids :

Urine :

Vomitus :

7. Color coding for bin:

Yellow:

Red :

Blue :

Black :
 PATIENT HANDLING AND TRANSPORTATION TO OPERATION THEATRE

General Anaesthesia

1) Drugs given
Premedication :
Induction :
Maintainence :

2) Endotracheal tube
PVC or Flexometallic :
Size :
Cuffed or uncuffed ETT :
Fixed length :

3) Inhalational agent:
Agent :
Volume % :

4) Ryle’s tube :

5) Position of surgery:

6) Reversal agent given:

7) Extubated/EPOV-

Regional Anaesthesia-Spinal/Epidural/Caudal/Plexus block/Pheripheral nerve blockade

1)Position-

2)Spinal needle

3)Epidural Needle-

4)Drug given-

5) Volume of drug -

6)Level of blockade-

7) Sensory or Motor –
 INTRODUCTION TO OPERATION THEATRE-

EQUIPMENTS

*Boyle’s apparatus –

*ECG electrodes-

* Pulse Oximetry –

* NIBP –

* Lights

*OT table-

*Suction apparatus-

*ET tube plaster

*Suction catheter –

*Ryle’s tube

*Saline bowl -

*Emergency drugs –

*Spinal needle –

*Epidural needle set -

*Endotracheal tubes check

*Diathermy –

*Foley’s catheter -

*Defibrillator-

*Ambu bag-

*Bains circuit-
 SUTURES

Absorbable sutures:

1.Plain catgut- 2.Chromic gut- 3.Vicryl- 4.Monocryl-

Non absorbable sutures:

1.Silk- 2.Polypropylene- 3.Polyethylene- 4.Nylon-

NEEDLE

1.Cutting-

2.Round body-

SUTURE TYPE

1.Vertical mattress-

2.Horizontal mattress-

3.Simple interrupted-

4.Continous subcuticular-
 RECOVERY ROOM AND POST OPERATIVE MANAGEMENT

Vitals:

Pulse rate:
Blood pressure:
Saturation:
Respiratory rate:
CVS –
Rs:

Modified Alderete Score:

Oxygenation/ Saturation:
Circulation:
Respiration:
Consciousness:
Movements:

Total score:

Patient shifted to :

Patient on room air Oxygen support Mechanical Ventilation:

Flow : Mode:

Tidal volume:

Respiratory rate:

FiO2:

PEEP:

ASSISTANT SIGN