Objective: This study aimed to assess the practice of manual perioperative anesthesia record-keeping in Debre Markos and Debre Berhan Comprehensive Specialized hospitals from May to June 2022. Methods: A descriptive study was undergone from May 1 to June 30, 2022 at two Hospitals that are under Amhara regional health bureau. To retrieve and analyze manual anesthesia record-keeping practice, a checklist was developed from manual perioperative anesthesia record sheet of study hospitals and the American society of anesthesiologists which comprises indicators with corresponding predefined components. The checklist comprised questions with three alternatives “complete” for full data recorded, “incomplete” for partial data recorded, and “No” for totally missed data. SPSS version 22 was used to analyze the data. Result: The name of the anesthetist was recorded as our expectation which means 100% complete. The name of the surgeon was the second most frequently recorded preoperative related indicator with a completion rate of 98.4%. Other preoperative indicators like last food/drink, current/previous medications, alcoholic/cigarette hx, pregnancy, cardiovascular, other system, and laboratory also not recorded in an eligible way. The anesthesia record completion rate was below fifty percent in many intraoperative indicators. Conclusion: and recommendation: Most of the perioperative anesthesia recording indicators were found poorly recorded or below the standards. Information about preoperative patient condition and identity, intraoperative drug administrations, monitoring related information, and postoperative orders regarding pain and fluid management are among inadequately/illegibly recorded indicators. We recommend different interventional strategies like training, refresher course on the importance of the anesthetic record, and regular feedback for anesthetists improves the practice of manual anesthesia record-keeping. Highlights