Page 1: Additional Patient Details
Patient Details
5.5.
Any co-existing disease? i.e. not the condition requiring surgery, e.g. respiratory, cardiac, neurological, renal, gastrointestinal, musculoskeletal, etc…
6.6.
Any recent (in the last month) previous surgical operation on the patient?
7.7.
Any pre-existing medication (6-24 hours before induction), excluding sedation drugs, e.g. antibiotics, NSAIDs, bronchodilators, mucolytics, steroids, antiulcers, etc..
Admission Details
9.9.
Case source. Was this case…
Pre-operative Evaluation
10.10.
Please indicate whether any of these pre-operative checks were done
Other pre-operative measures
11.11.
Were any intravenous fluids given before surgery?
a.11.a.
Why?
b.11.b.
What type?
12.12.
Was all the anaesthetic equipment checked prior to the operation?
b.12.b.
Were the checks performed using a checklist?