Surgical Travel Sheet

Enter patient information, review concentrations and doses, then print. The doctor can highlight orders and the team can document administration times by hand.

Patient nameDateWeightUnitSpeciesDoctorExam:Weight in kgASA1 2 3 4 5Technician

Calculated volumes are planning references. Verify the selected patient, product concentration, route, and ordered dose before administration. The workbook contains conflicting reference fields for some drugs; those entries require the doctor's independent order.

Pre-anesthetic assessment

TemperaturePulseRespirationCRTMucous membranes

Additional Notes

Print selected medications only

Medication orders and administration

Order	Medication / concentration	Calculated amount	Route	Calculation dose	Given at / initials

Procedure and Recovery Notes:

Discharge Alerts:

☐ Log controlled drugs☐ Invoice / notes☐ Home medications☐ Send records to rDVM☐ Call owner / discharge

Take-home medication orders

Order	Medication	Minimum	Maximum	Dose range	Frequency	Length / doctor’s order

Recommended diet / supplements

☐ Hill’s i/d ☐ Hill’s a/d ☐ Hill’s c/d ☐ Hill’s j/d ☐ Hill’s t/d
☐ Denamarin ☐ Dasuquin / Cosequin ☐ CET Chews

CRI syringe pumps

Set dose, concentration, duration and pump rate. For µg/kg/min, the calculation converts minutes to hours and µg to mg where required.

Order	Drug	Concentration	Dose	Duration (hr)	Pump (mL/hr)	Drug to draw	Diluent to add	Start / stop · infused / discarded

Fentanyl in 250 mL NaCl

☐ Fentanyl 0.05 mg/mL: ______ mL added to 250 mL NaCl Pump: ______ mL/hr Start: ______ Stop: ______

Fluids and bolus

Order	Item	Calculated amount	Doctor's order	Time / initials

Potassium supplementation

KCl 2 mEq/mL: verify serum K⁺, concentration and rate before use.

Serum K⁺	mEq / 250 mL	KCl mL	Max mL/kg/hr	Max mL/hr

Fluid / isoflurane monitoring

Time	Fluid rate	Isoflurane %	SpO₂ %	Heart rate	Respiratory rate	Notes