IndAgentInhalIso (5230) Intravenous Yes No Sodium Yes No (If Yes →) IndTypeIV (5240) Thiopental IndAgentIVSodT (5260) Ketamine Yes No IndAgentIVKet (5270) Etomidate Yes No IndAgentIVEtom (5280) Propofol Yes No IndAgentIVProp (5290) Fentanyl Yes No IndAgentIVFent (5300) Midazolam Yes No IndAgentIVMid (5310) Dexmedetomidine Yes No IndAgentIVDex (5320) Sufentanil Yes No IndAgentIVSuf (5330) Remifentanil Yes No IndAgentIVRem (5340) Intramuscular (IM) Yes No Ketamine Yes No (If Yes →) IndTypeIM (5350) IndAgentIMKet (5370) Midazolam Yes No IndAgentIMMid (5380) Regional Anesthetic Yes No RegionalAnes (5400) Regional Anesthetic Site: Thoracic Epidural Catheter Lumbar Epidural Catheter Caudal Epidural Catheter (If Yes →) Lumbar Epidural -Single shot Caudal Epidural Single shot – RegAnesSite (5410) Lumbar Intrathecal -Single Shot Other (If Yes Regional Anesthetic Drug: Bupivicaine Yes No Bupivicaine/Fentanyl Yes No →) RegAnesDrugBup (5420) RegAnesDrugBupFen (5430) Clonidine Yes No Fentanyl Yes No (Select all that RegAnesDrugClon (5440) RegAnesDrugFen (5450) Hydromorphone Yes No Lidocaine Yes No RegAnesDrugHydro (5460) RegAnesDrugLido (5470)
IndAgentInhalIso (5230) Intravenous IndTypeIV (5240) Yes No (If Yes →) Sodium Thiopental IndAgentIVSodT (5260) Yes No Ketamine IndAgentIVKet (5270) Yes No Etomidate IndAgentIVEtom (5280) Yes No Propofol IndAgentIVProp (5290) Yes No Fentanyl IndAgentIVFent (5300) Yes No Midazolam IndAgentIVMid (5310) Yes No Dexmedetomidine IndAgentIVDex (5320) Yes No Sufentanil IndAgentIVSuf (5330) Yes No Remifentanil IndAgentIVRem (5340) Yes No Intramuscular (IM) IndTypeIM (5350) Yes No (If Yes →) Ketamine IndAgentIMKet (5370) Yes No Midazolam IndAgentIMMid (5380) Yes No Regional Anesthetic RegionalAnes (5400) Yes No (If Yes →) Regional Anesthetic Site: RegAnesSite (5410) Thoracic Epidural Catheter Lumbar Epidural Catheter Caudal Epidural Catheter Lumbar Epidural -Single shot Caudal Epidural – Single shot Lumbar Intrathecal -Single Shot Other (If Yes →) Regional Anesthetic Drug: Bupivicaine RegAnesDrugBup (5420) Yes No Bupivicaine/Fentanyl RegAnesDrugBupFen (5430) Yes No (Select all that Clonidine RegAnesDrugClon (5440) Yes No Fentanyl RegAnesDrugFen (5450) Yes No Hydromorphone RegAnesDrugHydro (5460) Yes No Lidocaine RegAnesDrugLido (5470) Yes No
Congenital_DCF_Anesthesia_Sheet.docx