Anesthesia Care Plan

Surgical Considerations
Anticipated Procedure:
Surgery Requirements: (positioning, surgeon requests, muscle relaxants, block placement, etc)
Position:
Anticipated Surgical Time:
Estimated Blood Loss (EBL):
Anesthesia Concerns:

Preoperative Considerations
Patient Data:
Weight (kg):
NPO Status:
Allergies:
Medical History:
Anesthesia Concerns/Impact on plan:
Ways to Maximize Patient Preoperatively:
Lab Values:
(Correcting electrolyte/glucose imbalances, nausea prophylaxis, albuterol, infuse
blood/platelets, medical consultation, Chest x-ray, reschedule, etc)

Anesthetic Technique
General
General/IV sedation
MAC
-Intravenous
-Inhalational
-Rapid Sequence
(RSI)
Regional
PNB
-spinal
-epidural
-caudal
Local used:
-type:
-Bier Block
Comments/Reasoning:

Airway Management
Equipment:
Nasal Cannula
Mask
Size:
Intubation Method
Direct Laryngoscopy
RSI/Modified RSI
Awake/Asleep Fiberoptic
Flexible/Rigid Bronchoscope
Blind Intubation
C-spine traction
Comments:
LMA
Size:
Blades
Macintosh
Miller
Size:
ETT
Surgical Airway
Size:
-tracheostomy
-oral/nasal
-cricothyrotomy
-cuffed/uncuffed
-RAE, laser
-double lumen, uninvent
Ventilation
Hand Ventilate
Spontaneous/Assisted
Machine: VCV or PCV
-Tidal Volume:
RR:
Jet Ventilation
Apneic oxygenation
PIP:
PEEP:

Fluid Considerations
Intravenous Line(s):
-place IV/no IV
-place IV: pre-op/intra-op
-Location:
-size:
-number of IVs:
IV Line Details:
-10 or 60 drops/min
-Buretrol
-Extension tubing
-T-connectors
-extra stopcocks
Fluid Options:
-LR/NS
-Hespan
-Albumin
-PRBC (donor/autologous)
-platelets
-FFP
-other:
Administration: (standard, pressure bag, rapid transfuser, etc)
Comments:
Calculating Fluid Requirements:
Hourly Fluid Requirements:
(4-2-1 rule: 4ml/kg for first 10 kg, 2ml/kg for next 10kg, and 1 ml/kg for remainder)
Fluid Deficit: (NPO hours x hourly requirement):
(Replace half of deficit in first hour, divide rest into second and third hour)
Third Spacing:
-minimal surgery
-moderate tissue trauma
-extreme tissue trauma
3-4 ml/kg/hr
5-6 ml/kg/hr
7-8 ml/kg/hr
Insensible Loss:
(generally 2ml/kg/hr, add for urine excretion and bowel prep)
Replacement of Blood Loss:
(replace with crystalloid 3:1, or 1:1 for blood or colloids)
Fluid Replacement Schedule:
1st hour
Deficit
Maintenance
3rd Space
Insensible
Blood Loss
Replacement
TOTAL

2nd hour
3rd hour
4th hour
Blood Loss Concerns
Calculate Estimated Blood Volume (EBV):
Neonate (1-30 days old)
90 ml/kg
Infant (1 month to 1 year) 85 ml/kg
Child (1 year to puberty)
80 ml/kg
Male Adult
70-75 ml/kg
Female Adult
60-65 ml/kg
Calculate Maximum Allowable Blood Loss (ABL):
Max ABL=EBV x (Hcti -Hctl)/Hcta
Hcti=starting Hematocrit
Hctl=lowest allowable Hematocrit
Hcta=average hematocrit (Hcti + Hctl)/2

Monitors and Equipment
Standard Monitors:
Pulse oximeter, NIBP, Capnograph, EKG, (3 or 5 lead), FIO2 monitor, nerve
stimulator, precordial/esophageal stethoscope
Additional Monitors:
Arterial Line, central line, pulmonary artery line, foley, BIS monitor, ICP monitor,
Doppler, EEG, evoked potentials
Additional Equipment:
Bair Hugger (upper, lower, full body), fluid warmer, infusion pump, oral/nasal
gastric tube, axillary rolls, cushioning, padding, tourniquet
Comments:

Possible Pharmacological Intervention
(Nitroglycerin, beta-blocker, insulin, albuterol)

Anesthetic Agents
Premedication:
Agent:
Versed (IV, oral, nasal)
Glycopyrrolate
Fentanyl
Zantac/Reglan
Albuterol
Other (ABx):
Dose Range:
Explain technique/reasoning:
Spinal/Epidural/Caudal/Peripheral Nerve Block/Bier Block
Drugs:
Techniques:
Dosing Strategy:
Comments:
Induction:
Pre-oxygenation Technique:
Airway Management Strategy:
Drugs with doses:
Maintenance:
Gases:
Drugs:
Emergence:
Emergence/Extubation Technique:
Drugs with doses: (reversal)
Post-operative Transport/Care:
PACU vs ICU, oxygen, drugs (If transporting to ICU, what will you need for the
transport?)
Comments: