Get Pediatric Anesthesia Patient Consent Form 2011-2025

THIS CONSENT FORM IS DESIGNED TO MAKE YOU AWARE OF THE RISKS INVOLVED WITH LOCAL ANESTHESIA. THE RISKS INCLUDE, BUT ARE NOT LIMITED TO: A) THERE ARE RISKS OF ANESTHESIA THAT MAY AFFECT YOUR BODY, SUCH AS DIZZINESS, NAUSEA, VOMITING, ACCELERATED HEART RATE, SLOW HEART RATE, OR VARIOUS TYPES OF ALLERGIC REACTIONS.

In current medical practice, patients who have consented to surgery are considered to have implied consent to anaesthesia, even though anaesthesia is associated with its own particular set of risks and consequences that are quite separate from those associated with surgery.

An anesthesiologist best achieves the spirit of informed consent by asking questions such as, “Is this a plan you want to follow?” or “Do you wish to proceed?” Even the nonverbal patient can show authorization with a tap of the finger or a nod of the head.

I have been given an opportunity to ask questions about my anesthesia/analgesia methods, the procedures to be used, the risks and hazards involved, and alternative forms of anesthesia/analgesia. I believe that I have sufficient information to give this informed consent.

The medical staff will carefully explain the surgery to you before you have it. This includes why you are having it, any risks the surgery has, and what you can expect afterward. You will also be asked to sign an informed consent form. This form states that you understand everything about your surgery.

General anaesthesia or GA is a mixture of medicines given to your child to keep them asleep during surgery. Children can go to sleep for surgery by one of two ways – medicine can be given through a drip or gas can be breathed through a mask. You can stay with your child until they are asleep.