Airway
Mallampati IV
Aspiration
RSI consider
Anticoag
None active
OSA
STOP-BANG 5
ASA
III · METs ≥4
Blockers
Consent missing
Holding exam 10:46 · vitals from monitor Monitor
HR
82
NIBP
142/88
SpO₂
96%
RR
18
Temp
36.7
Pain
3/10
Mental status
A&Ox3, anxious about anesthesia given prior PCN reaction. Entered by me
NPO status
Solids 8h · clears 4h · meds with sip 5 AM. Entered by me
IV access
20g L forearm patent · saline lock. Entered by CRNA
Anesthetic plan
Technique
GA · ETT
GA · LMA
MAC
Spinal
Epidural
Block
Induction
RSI
Standard IV
Inhalation
Awake fiberoptic
Airway plan
Video laryngoscope · primary
Fiberoptic · backup
Two-provider induction
Lines/monitors
Standard ASA
2nd PIV
A-line
Train-of-four
Post-op
PACU continuous SpO₂
Multimodal · opioid-spare
Step-down
Difficult-airway equipment in room before induction. Two-provider, head-up RSI given GERD + obesity + Mallampati IV. Intra-op opioid sparing because of OSA.
— Plan note · Dr. Acosta · 10:46 · Entered by me
Consent · attestations
Surgical consent
Signed Apr 24 17:22 by Dr. Park · scope, sphincterotomy, possible stent. From EHR
Anesthesia consent
Verbal consent obtained 10:42. Awaiting signature page from front desk. Needs confirmation
Pregnancy
Post-menopausal · attestation accepted, no urine HCG. Entered by me
Blood product
No transfusion anticipated. T&S on file 04/24. From EHR
Pre-op sign · 13 fields 11/13 · 84%
Patient identity verified 2-source · MRN + DOB
10:42
Procedure & site confirmed Pt + Dr. Park · biliary tree
10:43
Allergy review · severity-tiered
10:43
NPO confirmed
10:42
Airway exam documented
10:34
ASA class assigned
10:46
Anesthetic plan recorded
10:46
Surgical consent verified
EHR
Anesthesia consent signed verbal only · paper inbound
pending
Code status confirmed
FULL
IV access patent
20g L
Difficult-airway cart in room requested · ETA 5 min
requested
Pre-op antibiotic plan cefazolin · PCN x-react risk noted, OK by ID 10:14
10:46
2 outstanding · neither blocks sign
Outstanding items route to review, not block sign. Walk-in can proceed under verbal consent + cart on the way.
— Severity taxonomy · v0.4
Considerations · cited, not prescriptive
RSI worth considering given GERD + BMI 30.9 + Mallampati IV. Final call yours.
Local protocol "Aspiration risk · induction" · ASA Practice Guidelines 2022
Cefazolin appears acceptable despite PCN anaphylaxis history per ID note 10:14 — published cross-reactivity 1–2% for cephalosporins with dissimilar side chains.
ID consult · Mar 2025 Stanford guideline · Pichichero 2018
Opioid-sparing commonly used with STOP-BANG ≥5. Multimodal regimen suggested in plan.
SAMBA OSA consensus 2023 · institutional pathway