Anesthesia Consent
It is important that you understand the potential risks before making the decision to go forward with anesthesia. By signing the consent for anesthesia, you are agreeing that you have read and understand the above anesthetic procedures and potential risks they carry. As the patient, you have the right to ask questions about your procedures so that you understand procedures and can make the decision to go forward with anesthesia. It is important that you discuss the possible risks and ask any questions you may have after reading this consent with your anesthesia provider before or on the morning of surgery.
The Problem
Performing foot surgery requires that the surgical site is blocked (or numbed) with local anesthesia. To administer this local anesthesia, we use needles and a local anesthetic block consisting of Xylocaine and Bupivacaine. These compounds will make the region that the surgery is being performed numb so that you do not feel pain during the procedure, however the administration of these compounds is often uncomfortable and can be painful.
Another problem is that during surgery you may hear sounds like the power saw and drill that may cause anxiety or make your nervous. This kind of response from the patient would hinder the performance of your surgeon, and increase your chances for a poor surgical result.
Alternatives to anesthesia
Although you have chosen to undergo surgery to correct your foot condition by receiving IV sedation anesthesia for your procedure, there are alternatives. Some foot surgeries can be performed utilizing a local anesthesia block only.
This kind of surgical experience is not for everyone however. It is very important that you are honest with yourself before you consider a “local block only” surgical procedure. Some of the factors that might dissuade you from choosing a local only procedure are:
Noises or sounds you might hear during surgery
Smells (from the cautery)
Sensations (vibration, pressure, possible pain) during the procedure
Choosing a local block type of anesthetic experience could ultimately impact the performance of your surgeon. Being awake during the surgical experience could cause you to react in a manner that distracts your surgeon from performing at the optimum level. The final decision to perform surgery under local anesthesia is made by your surgeon.
If local anesthetic surgery is not “the right fit” for you, and the risks associated with IV sedation outweigh the benefits, please consult with your surgeon for conservative solutions to your foot condition.
The Procedure
To create a surgical environment where the patient can be comfortable, sedation or M.A.C. (monitored anesthesia care) is often used so that the patient doesn’t feel the local block, and sleeps during the procedure.
During this process, M.A.C. Sedation is administered with I.V. (intra-venous) agents. These medications are injected into the I.V. line that is placed in the pre-op room by your nurse. Some of the medications you will receive in this I.V. will also relax you to help reduce any anxiety you have before the procedure.
You will meet your anesthesia provider before the administration of these medications and have an opportunity to ask any questions you have before the procedure or your anesthesia experience. It is important that you inform the anesthesia provider of any prior anesthesia experiences you have had so that they can make your current procedure as comfortable as possible.
Pre-Anesthesia Requirements
It is important that you consult with your primary care doctor for a pre-operative history and physical before your procedure. This will allow your primary care doctor to clear you for your anesthesia experience. Below is a list of the pre-anesthesia requirements you need to complete before you can proceed with any kind of I.V. Sedation.
Pre-Operative History & Physical
Visit with your primary care doctor to have a complete history and physical performed that clears you for anesthesia. It is important that any prior medical history, medical illnesses or conditions that might cause complications with anesthesia are discussed with your doctor to ensure your eligibility for anesthesia.
Pre-Operative Labs
Part of your pre-operative history and physical should include pre-operative labs. The labs your doctor will order will vary based on your age, your medical history and other factors that they will determine. These labs need to be part of your record before anesthesia is administered so that your anesthesia provider can also evaluate the results.
Pre-Operative EKG
If you have a history of heart conditions or are about 40 years of age, it is important that you have a pre-operative EKG so that your primary doctor as well as your anesthesia provider can evaluate and clear you for the administration of anesthesia.
Fasting
It is required that you maintain a fasting state, or that you DO NOT eat or drink anything after 10:00 PM the night before your procedure. If you take medications in the morning, it is important that you consult with your primary care doctor to see which medications you are supposed to take. You can take these medications with a small amount of water the morning of surgery.
Ultimately, always consult with your primary doctor about any medical history, prior anesthesia history and questions you have about medications or anesthesia risks so that you can proceed as a well informed and compliant patient.
Possible Complications Related to Anesthesia
Although modern anesthesia care is a highly advanced, the reality is that like any other medical procedure it involves a certain level of risk. Because of the nature of this kind of service, the risks can sometimes be severe. Doing your part as a compliant patient and informing your primary doctor as well your anesthesia provider will help mitigate some of these risks. Some of the risks and complications of anesthesia may include but are not limited to:
Allergic or adverse reaction
If you have had anesthesia or have known allergies to medications given during anesthesia, please advise your anesthesia provider.
Aspiration
It is crucial that you follow the NPO / Fasting requirements before your anesthesia experience. If you have eaten after 10 PM the night night before your surgery, there is a risk that you could vomit and aspirate during surgery.
Backache, muscle aches
Positioning during surgery and the effects of anesthesia medications can sometimes cause temporary muscle stiffness or backache. These discomforts typically resolve within a few days with rest and gentle movement.
Brain damage, Coma, Seizures
While extremely rare, severe complications affecting the brain can occur if there are unexpected reactions to anesthesia or issues with oxygen delivery. Your anesthesia team continuously monitors your vital signs to prevent and immediately address any concerns.
Dental injury
If you have had dental work or have prosthetic dental implants, veneers, or crowns, please advise your anesthesia provider so that the appropriate precautions can be taken. Even with precautions, there is a risk that dental damage may occur. Please discuss these risks with your anesthesia provider before surgery so that you are informed.
Headache, nausea
These are among the most common temporary side effects following anesthesia. Anti-nausea medications can be given during surgery to minimize these effects, and both symptoms typically resolve within 24-48 hours.
Inability to reverse the effects of anesthesia
In very rare cases, patients may take longer than expected to wake up from anesthesia. Your anesthesia team is trained to manage this situation and will provide appropriate supportive care until the effects naturally wear off.
Infection
Any time a needle is inserted into the body, there is a small risk of introducing bacteria. Your anesthesia provider uses sterile technique to minimize this risk, and any infections that do occur are typically minor and treatable.
Localized swelling and/or redness
Some patients may experience mild swelling or redness at injection sites. These reactions are usually temporary and resolve on their own within a few days of surgery.
Ophthalmic (eye) injury
If you have had eye surgery or suffer from eye conditions (like dry eye) please advise your anesthesia provider so that the appropriate precautions can be taken.
Pain, paralysis, positional nerve injury
Positioning during surgery or needle placement can occasionally cause temporary nerve irritation, resulting in numbness, tingling, or weakness. Most nerve-related effects are temporary and improve over time, though rare cases may be permanent.
Recall of sound/noise/speech by others
Some patients may have partial awareness or memory of sounds, conversations, or sensations during surgery. While this can be unsettling, it does not typically cause lasting harm, and your anesthesia team monitors your level of consciousness throughout the procedure.
Sore throat
If a breathing tube is used during your procedure, you may experience throat irritation or hoarseness afterward. This discomfort is temporary and usually resolves within 24-48 hours. Throat lozenges and warm liquids can provide relief.
Wrong site for injection of anesthesia
Your anesthesia provider will verify the correct injection site multiple times before administering any medication. In the rare event of incorrect placement, additional treatment may be needed to ensure proper anesthesia and manage any resulting effects.
Death
While anesthesia-related death is extremely rare in modern medicine (less than 1 in 100,000 cases), it remains a potential risk of any anesthesia. Your anesthesia team is highly trained in emergency management and continuously monitors your vital signs to ensure your safety throughout the procedure.
Please make sure to discuss any topics that concern you, well before the scheduled surgery date with your doctor. Part of our success is based on your understanding and ability to participate in a productive manner if an unfortunate complication occurs.
Consent for Anesthesia
I have read and understand the above anesthesia procedures and potential risks they carry. I understand that the potential benefits and outcomes cannot be guaranteed, and there are potential risks and complications that are associated with any surgical procedure and the accompanying anesthesia.
I understand that anesthesia is a specialty medical service, which manages patients who, are rendered unconscious or with diminished response to pain and stress during the course or a medical or surgical procedure.
During the course of the surgical procedure, conditions may require additional or different anesthetic monitoring or techniques, and I ask that the anesthesia provider provide any other necessary services for my benefit and well-being.
I agree and understand that no guarantees have been made by anyone regarding anesthesia services, which I am agreeing to have.
I agree and understand that I have been given the opportunity to ask questions about anesthesia care and have sufficient information to give this informed consent. I agree to the administration of the anesthesia prescribed for the my procedure. I recognize the alternative to acceptance of anesthesia for the procedure.
I understand that I will discuss concerns with my anesthesia provider the day of surgery before the procedure, and will not proceed with surgery if you still have questions or do not understand.
I am consenting to allow the scheduled anesthesia provider to perform anesthesia care during my surgery.