Anesthesia Record Sheet

Patient Name:

ID/No:

Age:

Weight:

Sex:

Date:

Operating Room:

Procedure:

Surgeon:

Anesthetist:

ASA Status:

Allergies:

Premedication:

Induction:

Maintenance:

Airway:

IV Fluids:

Start Time:

End Time:

Vital Signs

Time	BP	Pulse	SpO₂	EtCO₂	Temp	Resp

Drugs / Fluids Administered

Time	Drug/Fluid	Dose/Volume	Route

Remarks/Events

Recovery Room Notes: