Intraoperative Anaesthesia Chart

Patient & Case Information

Patient name MRN / ID Age Sex Weight (kg) Height (cm) ASA class Date of surgery Procedure Surgeon Anaesthesiologist Assistant / nurse Anaesthesia start Surgery start Surgery end Anaesthesia end

Allergies NPO status Comorbidities Current medications

Case status

Pre-operative Airway Assessment

airway scoring

Mallampati class Thyromental distance (cm) Inter-incisor gap (cm) Neck extension Dentition Upper lip bite test Predicted airway STOP-BANG / OSA risk

Difficult airway predictors

Obesity / short neck Receding mandible Protruding incisors Limited neck mobility Previous difficult intubation Beard / facial hair Facial / neck mass or radiation Large tongue

IV & Vascular Access

cannula gauge colour-coded

Site	Gauge	Attempts	Time inserted	Inserted by	Working?	Notes

Arterial line Arterial line gauge Central line Central line lumens / type

Intraoperative Vital Signs

recorded every 5 min or on change

HR (bpm) Systolic BP Diastolic BP SpO₂ (%) EtCO₂ (mmHg)

Time	HR	SBP	DBP	MAP	SpO₂ %	EtCO₂	RR	Temp °C	BIS	Rhythm	Notes

Chart redraws automatically from HR / SBP / DBP / SpO₂ / EtCO₂ columns as rows are added or edited.

Ventilation

Mode Tidal volume (mL) Respiratory rate (set) PEEP (cmH₂O) FiO₂ (%) I:E ratio Peak pressure (cmH₂O) Plateau pressure (cmH₂O) Volatile agent MAC / concentration O₂ flow (L/min) N₂O used

Medications Administered

induction, maintenance, analgesia, reversal, emergency drugs

Time	Drug	Dose	Unit	Route	Given by	Notes

Fluids, Blood Products & Output

Crystalloid type Crystalloid volume (mL) Colloid type Colloid volume (mL) PRBC (units) FFP (units) Platelets (units) Cryoprecipitate (units) Estimated blood loss (mL) Urine output (mL) Other losses (mL) Total fluids in (mL)

Net balance (auto, mL) Cell salvage used Glucose monitoring

Critical Events / Anaesthetic Emergencies

Tap a common event to log it with a time-stamp, or add a custom entry below.

Time	Event	Severity	Management / response	Outcome

Temperature Management & Positioning

Temp monitoring site Active warming device Patient position Table / bed adjustments

Pressure points padded Eyes protected / taped Limbs secured safely Diathermy pad applied correctly DVT prophylaxis (mechanical)

Emergence & Handover

Reversal agent Train-of-four ratio Extubation time Extubation criteria met Destination Post-op pain score Post-op nausea/vomiting Post-op airway status

Handover notes to PACU / receiving team

Sign-off

Anaesthesiologist (print name)

Time

Anaesthesia nurse / assistant (print name)

Time

Intraoperative Anaesthesia Chart

Staff sign-in

Cases

Patient & Case Information

Pre-operative Airway Assessment

Anaesthetic Technique & Airway Management

IV & Vascular Access

Intraoperative Vital Signs

Ventilation

Medications Administered

Fluids, Blood Products & Output

Critical Events / Anaesthetic Emergencies

Temperature Management & Positioning

Emergence & Handover

Sign-off