Morphine Yes No Ropivicaine Yes No RegAnesDrugMorph RegAnesDrugRop (5480) (5490) Ropivicaine/Fentanyl Yes No Tetracaine Yes No RegAnesDrugRopFen RegAnesDrugTetra (5500) (5510) Other Yes No RegAnesDrugOth (5520) Intercostal Nerve Infiltration by Surgeon or Anesthesia: Yes No IntNerveInf (5530) Regional Field Block by Surgeon or Anesthesia: Yes No RegFieldBlock (5540) ANESTHESIA Airway Yes No Airway In-situ (ETT or Tracheostomy): Airway Type: No airway support Simple face mask Bag-mask Nasal cannulae Laryngeal Mask Airway (LMA) Endotracheal intubation Tracheostomy (If LMA Airway Size : 1.0 1.5 2.0 2.5 3.0 4.0 5.0 →) (If Endotracheal intubation Airway Size (mm): 2.5 3.0 3.5 4.0 4.5 5.0 →) 5.5 6.0 6.5 7.0 7.5 8.0 Size not listed (DLETT, Tracheotomy) Cuffed Yes No (If Endotracheal intubation or Airway Site: Oral Nasal Tracheostomy Tracheostomy→) Endobronchial Isolation (DLETT, Bronchial Blocker) Yes No ICU Type Ventilator Used Intraop Yes No ANESTHESIA Transfusion Transfusion Yes No Transfusion (5630) (If Yes enter # of units or 0 if none ) Packed Red Blood Cells (PRBC)Units ______ PRBCUnits (5660) Platelet Pheresis Units ______ PlateletsPheresis (5690) Random Platelet Units ______ PlateletsDonor (5700) Fresh Frozen Plasma (FFP) Units ______ – FFPUnits (5730) Cryoprecipitate ______ – CryoUnits (5760) Whole Blood Units ______ – WholeBldUnits (5790)
Morphine RegAnesDrugMorph (5480) Yes No Ropivicaine RegAnesDrugRop (5490) Yes No Ropivicaine/Fentanyl RegAnesDrugRopFen (5500) Yes No Tetracaine RegAnesDrugTetra (5510) Yes No Other RegAnesDrugOth (5520) Yes No Intercostal Nerve Infiltration by Surgeon or Anesthesia: IntNerveInf (5530) Yes No Regional Field Block by Surgeon or Anesthesia: RegFieldBlock (5540) Yes No ANESTHESIA Airway Airway In-situ (ETT or Tracheostomy): Yes No Airway Type: No airway support Simple face mask Bag-mask Nasal cannulae Laryngeal Mask Airway (LMA) Endotracheal intubation Tracheostomy (If LMA →) Airway Size : 1.0 1.5 2.0 2.5 3.0 4.0 5.0 (If Endotracheal intubation →) Airway Size (mm): 2.5 3.0 3.5 4.0 4.5 5.0 5.5 6.0 6.5 7.0 7.5 8.0 Size not listed (DLETT, Tracheotomy) Cuffed Yes No (If Endotracheal intubation or Tracheostomy→) Airway Site: Oral Nasal Tracheostomy Endobronchial Isolation (DLETT, Bronchial Blocker) Yes No ICU Type Ventilator Used Intraop Yes No ANESTHESIA Transfusion Transfusion Yes No Transfusion (5630) (If Yes enter # of units or 0 if none ) Packed Red Blood Cells (PRBC)Units PRBCUnits (5660) ______ Platelet Pheresis Units PlateletsPheresis (5690) ______ Random Platelet Units PlateletsDonor (5700) ______ Fresh Frozen Plasma (FFP) – Units FFPUnits (5730) ______ Cryoprecipitate – CryoUnits (5760) ______ Whole Blood – Units WholeBldUnits (5790) ______
Congenital_DCF_Anesthesia_Sheet.docx