SOP - Anaesthesia Management

PIMS MEDICAL COMPLEX (PVT.) LTD.
STANDARD OPERATING PROCEDURE
SOP to monitor the clinical structures, processes and outcomes for

SOP Title:
continual improvement
Department: ADMINISTRATION PHC STAND.: 016 IND.: 50-56
Applies To: ALL CLINICS OPERATIONAL AND ALLIED DEPARTMENTS
Approved By: SOP No.: SOP/ADM/CQI/019/01
Issuance Date: JANUARY 25, 2023
Prof Dr Shams ur Revision Date: MARCH 20, 2025
Rehman: Superseded
Chief Executive Officer THIS IS FIRST VERSION
No.:
18 months issue
Valid Up To:
date
Dr Shahid Nisaar: Prepared By: DR MOHSIN SAJID
Medical Director Total Page: 9
Dr Mohsin Sajid Mr. Afsar Saaed

Director Operations & Admin. Quality Assurance Manager
Copy # Distribution Location Receive Date Signature
1. Chief Executive Office
2. Director Admin and HR office
3. Director Operations Office
4. Medical Officer Office
5. Q. A Manager Office
6. Nursing counter office
7. Emergency room
8. Document Control office
9.
10.
General Information:
1. Guidelines can be processes, procedures, flowchart, steps to follow, instructions, patient education.
2. Guidelines are applicable to PIMs.
3. Guidelines needs to be revised at least every eighteen months and/or if anything changes. If a
Guideline is reviewed, but have no changes, it is indicated on the original cover page as "revised
guideline without changes (thus it has to re-signed again)”
4. Attachments (e.g. documents, flowcharts etc. can be added as is (i.e. not necessary to be on a
page with a header)
5. Indicate the total number of pages.
6. SOP Number: Obtain from Director Operation & Admin.
SOP |Anaesthesia Services Page 1 | 9

PIMS MEDICAL COMPLEX (PVT.) LTD. STANDARD OPERATING PROCEDURE

SOP Title:
Rehman: Superseded
No.:
18 months issue
Valid Up To:
date
Archive: Director Administration retains original signed copy. A “Copy for Information” could be
issued upon request as per distribution list in case of authorized copy damaged or lost.


SOP Title:
Rehman: Superseded
No.:
18 months issue
Valid Up To:
date
1. PURPOSE:
1.1. The purpose of the procedure is to ensure the availability of safe anaesthesia care for
all surgical patients at PIMs.
2. SCOPE:
2.1. This SOP is applicable to all anaesthesia staff (full time, part time, contract employees,
interne) of PIMs inclusive of minor OT.
3. HEALTH, SAFETY AND ENVIRONMENTAL PROTECTION:
3.1. must wear PPEs (gloves, face mask, apron, and shoe cover) before………………...
4. RESPONSIBILITY:
4.1. It is the responsibility of all staff to follow this procedure.
4.2. It is the responsibility of Head of Department and In-Charge Indoor Care Services and
Manager Nursing to ensure that staff is familiar with the procedure and to monitor the
compliance.
5. TERMS AND DEFINITIONS:

5.1. PPEs – Personal Protective Equipment
5.2.
6. EQUIPMENT:
6.1. Trolly –
7. GENERAL INSTRUCTIONS & GUIDELINES:

7.1. PROCEDURE:
7.2. Pre-Anaesthesia Assessment

7.3. Identify patient correctly prior to interview and clinical evaluation. At least two
identifiers must be considered for proper patient identification. The positive
identification is recommended, where possible.
7.4. Anaesthesiologist (Medical Officer or above) inquires medical history from patient or
his/her guardian (in case of if patient is unable to communicate) OR reviews the
available medical information documented in patient file (or EMR).
7.5. History must include HPI (History of Present Illness), past medical or surgical history,
socio-economic history, family history and history of medications either during course


SOP Title:
Rehman: Superseded
No.:
18 months issue
Valid Up To:
date
of hospitalization or home care. Therefore, it is emphasized that patient’s history must

be filled properly on ‘history form’ and/or in HIMS.
7.6. Perform the examination which will provide information that might assist in decision
regarding anaesthesia and its management. Examination must include cardiac
evaluation, respiratory evaluation, general physical examination, examination based on
ASA classification and hygiene of patient. Of course! Refer to concerned department
for specialist consultation if required.
7.7. Order laboratory and imaging investigations necessary to conduct anaesthesia
according to protocol for investigation required for surgical patients undergoing
anaesthesia. The investigations must be entered in HIMS as well as on continuation
sheet.
7.8. Based on disease status and condition of patient anaesthesiologist assigns ASA class to
the patient according to classification defined by American Society of Anaesthesiologist
(ASA); expressed in appendix-I.
7.9. All findings must be documented on “Pre-Operative Anaesthesia Assessment Form”.
Note: as the manual workflows are being replaced with automated workflows by
implementing Hospital Information Management System at PRH, so the pre-operative
anaesthesia assessment form will be provided in HIMS.
7.10. ANAESTHESIA PLAN:

7.11. Based on pre-operative assessment and examination, Anaesthesiologist plans the pre-
anaesthesia approach and orders on the Pre-operative Anaesthesia Assessment Form
as well as in patient’s file.
7.12. Anaesthesia approach is defined based on assessment and examination and must be
written in patient’s file and/or in HIMS (patient’s EMR).
7.13. Informed Consent
7.14. Informed consent must be obtained in according with the procedure established for
informed consent.
7.15. Perianesthic Care
7.16. Speak up and identify the patient correctly; at least two patient’s identifiers must be
considered. A member of anaesthesia team speaks patient’s MRN, name and age and
other member will confirm the identifiers with the patient record. It recommended that
positive identification should be done, where applicable. Note: Time-out sheet should be
filled and signed properly.
7.17. Re-evolution of patient should be done immediately prior to induction to compare the
findings and management plan in the formal pre-anaesthesia assessment with immediate
pre-induction evaluation.


SOP Title:
Rehman: Superseded
No.:
18 months issue
Valid Up To:
date
7.18. Any change in condition and medication should be documented on the intra-operative
anaesthesia record that will become the part of patient medical record.
7.19. Preparation and check of equipment according to anaesthesia Equipment Pre- Check List,
drugs, fluids, and gas supplies must be done prior to induction of anaesthesia.
7.20. Selection and administration of anaesthesia agent must be done to render the patient
insensible to pain, while providing a level of comfort and relaxation commensurate with
the invasiveness and physiological stress of the planned procedure.
7.21. Appropriate monitoring of patient during anaesthesia must be done which includes
regular and periodical recording of the heart rate, cardiac rhythm, respiratory rate, blood
pressure, oxygen saturation, airway security and patency and level of anaesthesia.
7.22. All the findings must be documented in the Anaesthesia Record Sheet.
7.23. Post-Anaesthesia Monitoring

7.24. A member of anaesthesia team (who is knowledgeable about patient’s condition)
transports the patient to recovery area. The patient is monitored continuously and
treated during transport with monitoring and support appropriate to the patient’s
condition.
7.25. Patient condition in recovery area should be continuously monitored and documented by
nurse. Monitoring includes blood pressure, pulse rate, respiratory rate, level of
consciousness, oxygen saturation measurement, drug administered, IV infusion and pain.
7.26. Discharge from Recovery Area
7.27. In order to discharge the patient from recovery area, the following criteria is
established:
a. The patient is fully conscious without excessive stimulation, able to maintain clear
airway, and exhibits productive reflexes;
b. Respiration and oxygenation are satisfactory;
c. The cardiovascular system is stable with no unexplained cardiac irregularity or
persistent bleeding. The specific values of pulse and blood pressure should
approximate to normal pre-operative values or be at an acceptable level
commensurate with the planned postoperative care. Peripheral perfusion should
be adequate.
d. Pain and emesis should be controlled and suitable analgesic and anti-emetic
regimens prescribed.
e. Temperature should be within acceptable limits. Patients should not be returned
to the ward if significant hypothermia is present.
f. Oxygen and intravenous therapy, if appropriate, should be prescribed.
7.28. Discharge from the recovery area is the responsibility of the anaesthetist but the
adoption of strict discharge criteria allows this to be delegated to recovery staff.


SOP Title:
Rehman: Superseded
No.:
18 months issue
Valid Up To:
date
7.29. If the discharge criteria are not achieved, the patient should remain in the recovery area
and the anaesthetist should be informed.
7.30. An anaesthetist must be available at all times when a patient who has not reached the
criteria for discharge is present in the recovery room.
7.31. If there is any doubt as to whether a patient fulfils the criteria, or if there has been a
problem during the recovery period, the anaesthetist who administered the anaesthetic
(or another anaesthetist with special duties in the recovery room) must assess the
patient.
7.32. After medical assessment, patients who do not fulfil the discharge criteria may be
transferred to Intensive Care Unit.
7.33. Handing over to ward staff:
7.34. Patients should be transferred to the surgical ward accompanied by a suitably trained
member of staff and caretaker.
7.35. The anaesthetic record, together with the recovery and operation notes, post-operative
orders, must accompany the patient.
7.36. The recovery staff must ensure that full clinical details are relayed to the ward nurse
with particular emphasis on problems and syringe pump settings.
7.37. Local Anaesthesia
7.38. The principles of management in any patient undergoing local anaesthesia, either alone
or as part of a general anaesthetic technique, are the same as any other patient.
7.39. Apply monitor to patient for:
a. BP (every 5 minutes)
b. ECG (If hypertensive or ischemic heart disease)
c. Pulse Oximetry
7.40. Maintain I/V Line iv. O2 by mask or nasal prongs @ 5—8 L/min, if:
a. Surgery on head and neck
b. Age > 60 years
c. Hypertensive /IHD
7.41. Information given on handover to recovery staff should include site and type of local
block; drug and dosage used and anticipated duration of action.
7.42. Instructions forwarded to staff should include further pain relief and positional
restrictions for the patient.
7.43. Information for the patient includes the anticipation of return of sensation and/or
motor function, care with hot and cold items and weight-bearing.
7.44. Considerations after spinal and epidural anaesthesia include noting the level of
analgesia achieved, cardiovascular status, sitting up (when and how much), bladder
care, details of any continuous infusions, degree of motor block and time of likely


SOP Title:
Rehman: Superseded
No.:
18 months issue
Valid Up To:
date
recovery. Many of these considerations apply also to plexus block. Documentation must
be done on Anaesthesia Assessment Form.
7.45. RECORDS
a. Preoperative Anaesthesia Assessment Form
b. Informed Consent Form
c. Pre-check Anaesthesia Equipment List
d. Post Anaesthesia Recovery Record Form
e. Patient’s Medical Record (Patient’s File)
7.46. SUPPORTING PROCEDURES

a. SOP for Patient identification
b. SOP of informed consent for healthcare
8. PROCESS AND PROCEDURE:

8.1. Role and responsibility of anaesthesia staff.
RESPONSIBILITY PROCEDURES EXPLANATION
ABC – Ⓐ
ABC – Ⓑ
XYZ – Ⓒ
ABC – Ⓓ
MNO – Ⓔ
XYZ – Ⓕ


SOP Title:
Rehman: Superseded
No.:
18 months issue
Valid Up To:
date
1. INTERPRETATION:
There is no interpretation in this SOP.
2. REFERENCE:
1.1.Punjab Healthcare Commission – Standard No. 025 and Indicator No.92–100.
1.2. http://my.clevelandclinic.org/health/treatments_and_procedures/hic_ASA_Physical_Clas
sification_System
1.3. http://www.asahq.org/resources/clinical-information/asa-physical-status-classification-
system
3. ANNEXURES:
1.1.Annexure – 1 Physical Classification of the American Society of Anaesthesiologists (ASA)
1.2.Annexure – 2
1.3.Annexure – 3
DOCUMENT CHANGE RECORD:
REVIEW REVIEW DATE IDENTIFICATION

DESCRIPTION OF CHANGE
No. (DD–MM–YYYY) OF CHANGE
00 23 Nov. 2022 There is no change of history in 1st ver. of the SOPs.


SOP Title:
Rehman: Superseded
No.:
18 months issue
Valid Up To:
date
1.1. Annexure – 1 Physical Classification of the American Society of Anaesthesiologists

(ASA)
Status Disease State

ASA Class I No organic, physiologic, biochemical, or psychiatric disturbance.
ASA Class II Mild to moderate systemic disturbance that may or may not be
related to the reason for surgery. Examples: Heart disease that
only slightly limits physical activity, essential hypertension,
diabetes mellitus, anemia, extremes of age, morbid obesity,
chronic bronchitis
ASA Class III Severe systemic disturbance that may or may not be related to
the reason for surgery, (does limit activity) Examples: Heart
disease that limits activity, poorly con-trolled essential
hypertension, diabetes mellitus with vascular complications,
chronic pulmonary disease that limits activity, angina pectoris,
history of prior myocardial infarction.
ASA Class IV Severe systemic disturbance that is life-threatening with or
without surgery. Examples: Congestive heart failure, persistent
angina pectoris, advanced pulmonary, renal, or hepatic
dysfunction
ASA Class V Moribund patient who has little chance of survival but is
submitted to surgery as a last resort (resuscitative effort)
Examples:
Uncontrolled haemorrhage as from a ruptured abdominal
aneurysm, cerebral trauma, and pulmonary embolus.
Emergency Operation (E) Any patient in whom an emergency operation is required Example: An
otherwise healthy 30-year-old woman who requires a dilation and
curettage for moderate but persistent haemorrhage (ASA Class 1 E)

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PIMS MEDICAL COMPLEX (PVT.) LTD.

STANDARD OPERATING PROCEDURE

SOP to monitor the clinical structures, processes and outcomes for

Dr Mohsin Sajid Mr. Afsar Saaed

Copy # Distribution Location Receive Date Signature

1. Chief Executive Office

2. Director Admin and HR office

3. Director Operations Office

4. Medical Officer Office

6. Nursing counter office

8. Document Control office

SOP |Anaesthesia Services Page 1 | 9

SOP to monitor the clinical structures, processes and outcomes for

SOP |Anaesthesia Services Page 2 | 9

SOP to monitor the clinical structures, processes and outcomes for

5. TERMS AND DEFINITIONS:

7. GENERAL INSTRUCTIONS & GUIDELINES:

7.2. Pre-Anaesthesia Assessment

SOP |Anaesthesia Services Page 3 | 9

SOP to monitor the clinical structures, processes and outcomes for

of hospitalization or home care. Therefore, it is emphasized that patient’s history must

7.10. ANAESTHESIA PLAN:

SOP |Anaesthesia Services Page 4 | 9

SOP to monitor the clinical structures, processes and outcomes for

7.23. Post-Anaesthesia Monitoring

SOP |Anaesthesia Services Page 5 | 9

SOP to monitor the clinical structures, processes and outcomes for

SOP |Anaesthesia Services Page 6 | 9

SOP to monitor the clinical structures, processes and outcomes for

7.46. SUPPORTING PROCEDURES

8. PROCESS AND PROCEDURE:

SOP |Anaesthesia Services Page 7 | 9

SOP to monitor the clinical structures, processes and outcomes for

DOCUMENT CHANGE RECORD:

REVIEW REVIEW DATE IDENTIFICATION

SOP |Anaesthesia Services Page 8 | 9

SOP to monitor the clinical structures, processes and outcomes for

1.1. Annexure – 1 Physical Classification of the American Society of Anaesthesiologists

Status Disease State

SOP |Anaesthesia Services Page 9 | 9

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