YesNo
yes Premedication Dose
Midazolam
Fentanyl/ Sufentanil
yes Induction Dose
Propofol/ Etomidate/ Nesdonal
Muscle relaxant: Atracurium/ Pavulon
Cisatracurium
yes Premedication Dose
Maintenance drug
Propofol/ Inhaling gas
Muscle relaxant: Atracurium/ Pavulon
Reversal of muscle relaxation: Prostigmin/ Atropine
Morphine
Dexamethasone/ Ondansetron
Opiate: fentanyl/ Sufentanil
yes Post-op pain control Dose
Pain killer pump
Opiate, at the end of procedure
yes fixation
Abdomen
Thighs
Legs
Feet
yes Fixation method
Belt
Bandage
Tape
yes Specify
Proximal Roux length (<250 cm)
Distal Roux length (<250 cm)
yes Reinforcement
Suturing
Clips
Ligature
YesNo
yes operations
Liver biopsy
Drain placement at gastro-jejunostomy anastomosis
Gastrostomy
Gastrorrhaphy
Trocar site repair
Unplanned splenectomy
Crural repair
Gastrectomy
Cholecystectomy
Diagnostic EGD/EGJ
Vagotomy
Incisional hernia repair
Panniculectomy
Planned fiberoptic intubation
Lysis of extensive adhesions
Umblical hernia repair
Ovarian cyst drainage
Enterolysis
Drain placement
Adjustable band removal
Hiatal hernia repair
YesNo
yes Test result management
Air through NG tube (box) PositiveNegative
Air through endoscope PositiveNegative
Methylene blue test PositiveNegative
YesNo
Beforeafter
YesNo
yes Method When Order after OP Duration of use
Compression stockings
elastic bandage
intermittent compression device
LMW heparin
Subcutaneous heparin 5000 units
Other heparin dosage
Other anticoagulation
Prophylactic IVC filter
Foot pump
YesNo
yes unprecedented events
Equipment/instrument malfunction
Revision of anastomosis
Injury to other organs requiring repair
Blood transfusion
Complications of anesthesia
Subcutaneous emphysema
Other
yes Injury to other organs
Spleen, grade
Liver
Small intestine
Colon
Stomach
Vascular injury
Other
YesNo
YesNo
Drug Prophylaxis therapeutic
SC heparin 5000 units
Heparin with other doses
LMWH
Other
YesNo
yes Pain control
Thoracic epidural
Abdominal epidural
Patient controlled anesthesia (PCA)pump
Oral narcotics
Intermittent IV narcotics
Tylenol
NSAID
Other
YesNo
yes complications During 30 days after operation
reoperation
gastrojejunostomy leak
jejunojejunostomy leak
pancreatitis
Postoperative bleeding
Abdominal abscess
Esophageal injury
Wound infection
Fasial dehiscence
Seroma
Small bowel obstruction
Obstruction:
Location:
Etiology:
Internal hernia
Adhesions
Anastomosis obstruction
Unknown
Clot bezoar
Other
Stomal/ gastric outlet obstruction
Stomal stenosis
Peptic ulcer
Atelectasis
Pneumothorax
Pleural effusion
Pulmonary embolism
DVT
Pneumonia
Respiratory failure requiring intubation
UTI
Renal failure
Diagnosed by:
TIA
Stroke
Urinary retention
Bed sore
Rhabdomyolysis
Jaundice
Hepatitis
Liver failure
Acute cholecystitis/ biliary colic
Cholestasis/ gallstone
Poor intake
Arrhythmias
Persistent tachycardia
MI
Cardiac arrest
Neuropathy
Myalgia/ paresthesia
Low back pain
Death
Other
yes Post operative Bleeding
upper intestine
lower intestine
intra-peritoneal
unknown
other
yes Abdominal abscess location
LUQ
subhepatic
lower abdomen
interloop
other
YesNo