Anesthesia Consent

The practice of anesthesia and medicine is not an exact science. The reactions of each person can vary. Even when performed correctly, any anesthetic procedure can be associated with the very remote risk of death, paralysis, or serious bodily injury. Following are brief descriptions of the various types of anesthesia available to you, including benefits and risks of the particular type of anesthetic selected. Please read through them carefully, and discuss them in detail with your anesthesiologist.

  • GENERAL ANESTHESIA: You are given medications either intravenously or as a gas, or both, to render you unconscious and unresponsive to pain. In effect, you will simply close your eyes, and when you open them, the surgery will be over. You do not dream, nor do you hear or remember anything. While you are asleep, a soft plastic breathing tube may be placed into your mouth and/or into your windpipe for you to breathe through. Because you are asleep, you are not aware that this is done, and it will be removed before you are awake. Side effects of general anesthesia are rare, and can include a risk of injury to the teeth or vocal cords, a mild sore throat (both associated with the placement of the breathing tube), nausea and/or vomiting, and sleepiness, or confusion post-operatively. Serious complications, such as death, stroke, paralysis, etc., are possible, although extremely remote, with the incidence reported as less than 1 in 100,000. Overall, general anesthesia is considered very safe. By using short acting anesthetic agents, your recovery period is short. You can expect to be fully awake and discharged home within one to two hours after surgery.
  • EPIDURAL/SPINAL ANESTHESIA: After numbing the skin, a spinal or epidural needle is inserted into the lower back. Local anesthetic is injected into the area around the spinal cord. This “numbs” the nerves to the lower body causing loss of sensation, allowing you to undergo surgery comfortably. If desired, small amounts of sedation can be given to induce sleep during the procedure. Complications are rare, and can include a mild backache with muscle spasms at the site of injection, headache, or urinary retention (difficulty with voiding). If this occurs, a catheter can be temporarily inserted into the bladder for relief. During the block, your legs are “paralyzed”, and you will not be able to use them until the anesthesia has worn off (generally three to four hours). However, the risk of permanent paralysis is extraordinarily remote, and in fact, is no more common with this type of anesthesia than with general anesthesia, and is nearly non-existent either way.
  • NERVE BLOCK: This involves the injection of local anesthetic into the area around a nerve, thereby causing ‘numbness’ to the desired area, thus allowing surgery. This is especially suitable for surgery on the arm or leg. Occasionally, you may notice bruising or soreness around the area of injection. If desired, sedation can be given while the block is being done, and during the surgery, to relieve any anxiety you may have. The risk of transient or permanent injury to the nerve is possible, although very rare.
    • – INTERSCALENE NERVE BLOCK: An interscalene nerve block involves inserting a needle into the side of the neck. Local anesthetic is then injected that makes the shoulder and arm numb. Potential side effects/risks include: infection, bleeding, pneumothorax, hoarse voice, Horner’s syndrome (droopy eyelid, pinpoint pupil and dry, flushed face), difficulty breathing, nerve damage, and incomplete nerve block.
    • – AXILLARY NERVE BLOCK: An axillary nerve block involves inserting a needle under the arm and injecting local anesthetic which blocks nerve conduction temporarily and makes the arm and hand numb. Potential side effects/risks include infection, bleeding, nerve damage, or incomplete nerve block.
    • – FEMORAL NERVE BLOCK: A femoral nerve block involves inserting a needle in the groin area and injecting local anesthetic, which block nerve conduction temporarily and makes the leg numb. Potential side effects/risks include: infection, bleeding, nerve damage, and incomplete nerve block.
    • – POPLITEAL NERVE BLOCK: Popliteal and saphenous nerve blocks involve inserting a needle behind and around the knee and injecting local anesthetic, which blocks nerve conduction temporarily and makes the leg below the knee numb. Potential side effects/risks include: infection, bleeding, nerve damage, and incomplete nerve block.
    • – BIER BLOCK: A tourniquet is placed on the arm, and local anesthetic is injected into the vein through an IV catheter. This numbs the arm. The block lasts about an hour.
  • MONITORED ANESTHESIA CARE (MAC): Neither general nor regional anesthesia is utilized. You receive sedation during the case while the surgeon uses local anesthesia at the site of surgery to numb the surgical site. This is commonly referred to as “twilight sleep”. You should not feel pain and will be very relaxed, and often, will sleep through the procedure. During the procedure, you are monitored closely. This type of anesthesia has few side effects, and recovery is quick.

PATIENT STATEMENT: I understand that this information is provided so that I can make an informed choice about the type of anesthetic I will be given. I understand and give consent to the anesthetic planned, and further understand that my anesthesiologist may need to change anesthetic choices or certain aspects of the anesthetic plan due to circumstances that may arise during surgery. I have read this form, and understand that I have the opportunity to ask questions and discuss the anesthetic plan with the anesthesiologist responsible for my care.

I consent to the performance of anesthetics, as appropriate. I understand that receiving anesthesia, even though carefully administered, may involve serious risk(s). For twenty- four (24) hours after receiving anesthesia, I understand that I am not to drive, operate heavy equipment, drink alcohol, or make legal decisions. I further understand that a responsible adult must be with me for the first twenty-four (24) hours after receiving anesthesia.

Proceed to Authorization and Assignment of Benefits