A single-sheet combined anaesthetic record and consent form.

In 1932 Tovell and Dunn described the use of anaesthetic records at the Mayo Clinic. The method employed was based on the Hollerith punch-card for use with a sorting and tabulating machine. This punch-card system gained wide popularity in the United States and was adopted by the American Society of Anesthetists in 1937 (Saklad, 1940). In the same year Nosworthy complained that the practice of keeping routine anaesthetic records had received little attention in diis country (Nosworthy, 1937). He listed the following advantages of keeping anaesthetic records: (1) Statistical. (2) Any significant pre-operative findings can be seen at a glance before induction, together with records of any previous anaesthetics. (3) The periodic recording of pulse rate, blood pressure and other parameters encourages closer observation of the patient during the operation. (4) A chart of parameters aids quicker appreciation of the patient's condition and earlier opportunity to correct an undesirable state. (5) It allows a quicker assessment of the patient's state and behaviour if a more experienced anaesthetist is called, or the anaesthetists change during an operation. (6) The record can be used as a teaching aid. (7) The surgeon may realize the effects of his techniques or the posture of the patient and the knowledge may lead to modifications which improve postoperative results. To these may be added: (8) Information on the anaesdietic record supplied to the recovery ward allows greater continuity of treatment in the immediate postoperative period. (9) The record is readily available should it be needed for medico-legal purposes. Punch-card systems involve the use of a codebook and sorting machine. Completion of the form is a lengthy and complicated procedure. To overcome these disadvantages Nosworthy introduced his card system in 1943 (Nosworthy, 1943). Cards are dipped by hand and can be sorted with a knitting-needle. Another method is the Cardiff anaesthetic record system (Mushin et al., 1954). This is a four-page, self-coding record from which data are transferred to a Hollerith punch-card by hand. Mechanical sorting and tabulation are carried out yearly. The use of any record system for statistical purposes thus entails the completion of a complex form and the involvement of statistical and clerical staff. The advantages to be gained from such a system fully justify its use whenever possible, but in the day-to-day work of many anaesthetic departments information retrieval and statistical analysis are not important objectives. In such cases a simple, quickly completed form is to be preferred, provided it retains the other advantages listed by Nosworthy. A record of this type has been used at the Royal Marsden Hospital for the past year.