Veterinary Anesthesia Monitoring Record
Pre-anesthetic · Drugs · Monitoring · Recovery
ASA status
01
Pre-anesthetic
02
Drugs administered
| Phase | Drug | Conc. (mg/mL) | Dose (mg/kg) | Dose (mg) | Volume (mL) | Route | Time | Initials |
|---|---|---|---|---|---|---|---|---|
| Premedication | ||||||||
| Premedication | ||||||||
| Induction | ||||||||
| Induction | ||||||||
| Maintenance | ||||||||
| Local / regional | ||||||||
| Analgesia | ||||||||
| Reversal | ||||||||
| Other |
03
Fluids & machine
Monitoring & support in use
04
Monitoring
Record at least every 5 minutes| Minutes | +0 | +5 | +10 | +15 | +20 | +25 | +30 | +35 | +40 | +45 | +50 | +55 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Clock time | ||||||||||||
| HR (bpm) | ||||||||||||
| RR (brpm) | ||||||||||||
| SpO₂ (%) | ||||||||||||
| EtCO₂ (mmHg) | ||||||||||||
| SAP / MAP / DAP | ||||||||||||
| Temp | ||||||||||||
| Inhalant % | ||||||||||||
| O₂ flow (L/min) | ||||||||||||
| Fluid rate | ||||||||||||
| Depth / reflexes | ||||||||||||
| Notes |
05
Timeline
06
Recovery
Recovery quality
Anesthetist signature
Veterinarian signature