Preoperative Checklist

Patient Name: ………………….. Date of Surgery: ………………….. Procedure: ………………….. Surgeon: ………………….. Hospital ID (SIP/NHC): …………………..

• [ ] Confirmed full name and ID with patient
• [ ] Correct side and site marked
• [ ] Consent form signed and scanned
• [ ] Allergy status documented

• [ ] Complete medical history reviewed
• [ ] Neurological exam updated (GCS, focal signs)
• [ ] Seizure history evaluated (if applicable)
• [ ] ASA classification assigned: _ * [ ] Functional status recorded (e.g. Karnofsky/Rankin): _

• [ ] MRI reviewed
• [ ] CT reviewed
• [ ] Neuronavigation data uploaded (if applicable)
• [ ] Vascular imaging reviewed (CTA/MRA/DSA)
• [ ] Functional imaging (fMRI/DTI) evaluated (if required)

• [ ] CBC
• [ ] Coagulation profile
• [ ] Electrolytes, renal function
• [ ] ECG (if >40 or cardiac history)
• [ ] Anesthesia evaluation completed
• [ ] COVID test (if required)

• [ ] Antiepileptics continued (if indicated)
• [ ] Anticoagulants/antiplatelets managed appropriately
• [ ] Corticosteroids administered (if edema/mass effect)
• [ ] Antibiotic prophylaxis ordered
• [ ] DVT prophylaxis planned
• [ ] Bowel prep (if spinal or indicated)
• [ ] Blood group and crossmatch done

• [ ] ICU / HDU bed reserved
• [ ] Neuronavigation system available
• [ ] Microscope / endoscope / neuro-monitoring prepared
• [ ] Special equipment (clip, shunt, stimulator) ready

• [ ] NPO status confirmed
• [ ] Preop hygiene and shaving (if needed)
• [ ] Jewelry and prostheses removed
• [ ] Psychological support offered

• [ ] Surgical team briefing completed
• [ ] Surgical pause/time-out planned

• [ ] All documentation uploaded to EHR
• [ ] Checklist reviewed and signed by responsible physician

Signed by: ……………………………….. Date/Time: ………………………………..