Pre-Sedation and Pre-Anaesthesia Assessment
ASA class, airway, fasting, medicines, allergies, previous anaesthesia — the one page completed before any sedation or anaesthetic, anywhere in the facility
What it is
A pre-procedure assessment for sedation and anaesthesia: ASA physical status, airway assessment (Mallampati, mouth opening, neck movement, dentition), fasting status, cardiorespiratory history, medicines and allergies, previous anaesthetic problems, the plan (level of sedation, monitoring, who administers), and the consent line.
Where to use it
Before every sedation or anaesthetic — endoscopy, dental, radiology, emergency department, theatre; in the record. Evidence for: Hospital Standard 4 — anaesthesia and sedation safety; Universal Floor — consent. Evidence for: Hospital Standard 4 — anaesthesia and sedation safety; Universal Floor — consent. Evidence for: Hospital Standard 4 — anaesthesia and sedation safety; Universal Floor — consent.
Translate and adapt
English master edition. Georgian and other translations are added as they are clinically reviewed. Any facility may translate, add its logo and adapt wording to local practice — keeping the ASF block, the source attribution and the licence line on the sheet. Clinical thresholds and drug doses must be confirmed against national protocols before use.
The same code is printed on the tool itself. Scan it in any facility to reach this page.
Procedural Sedation — Monitoring Record
Difficult-Airway Trolley — Contents and Daily Check
Recovery and Discharge After Sedation or Anaesthesia — Criteria Score
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