Dept.
of ANESTHESIOLOGY
ALDRETE SCORE CHART UHID : ..........................
Name : ................................................................................................ Age / Sex ...................... IP NO ...........................
RA / GA : ....................................... Procedure : .................................................................................................................
Patient’s Score
1st Hour 2nd Hour 3rd Hour 4th Hour 5th Hour 6th Hour 7th Hour
Respiration :
2 = Able to take deep breath and cough
1= Dyspnea / Shallow breathing
0 = Apnea
O2 Saturation :
2 = Maintaing > 92% on room air
1 = Needs O2 inhalation to maintain > 90%
0 = < 90 % even with supplemental oxygen
Consciousness :
2 = Fully awake
1 = Arousable on calling
0 = Not responding
Circulation :
2 = BP K20mm Hg Pre op
1 = BP K20 - 50mm Hg Pre op
0 = BP K 50mm Hg Pre op
Activity :
2 = Able to move 4 extremities
1 = Able to move 2 extremities
0 = Able to move 0 extremities
TOTAL
HR
This system is designed to assess the patients transition from phase I recovery to Phase II
recovery, from discontinuation of anesthesia until return of protective reflexes and motor function.
This total score is 10. Patients scoring J 8 ( and / or are returned to similar pre op status) are
considered fair for transition to phase II recovery.
Date :
Time : Signature
SH / ICU / R - 31
WONG - BACKER FACES PAIN RATING SCALE
0 1 2 3 4 5
NO HURT HURTS HURTS HURTS HURTS HURTS
LITTLE BIT LITTLE MORE EVEN MORE WHOLE LOT WORST
0 - 10 Numeric Pain Intensity Scale
0 1 2 3 4 5 6 7 8 9 10
No Mild Pain Moderate Severe Worst
Pain Pain Pain Possible
[Link] Time Score Medications Sign.
ANESTHESIA EVENT MONITORING CHART
Under lying diseases :
Surgical Procedure
Anesthesia management :
Elective / Emergency Peri operative mortality risk : Yes / No
[Link] EVENT
st
1 Hour 2nd Hour 3rd Hour 4th Hour 5th Hour Management
1. Airway Obstruction
2. Respiratory Failure
3. Bleeding
4. PONV
5. Post op shivering
6. Arrythmias
7. Agitation
8. Pain
9. Haemodinamic instability
Staff Sign Anaesthetist sign
SH / ICU / R - 32