SARATOGA VETERINARY HOSPITAL
ANESTHESIA RELEASE FORM
File# <folder>
<date>
Before placing <animal> under anesthesia we will perform a complete physical examination. Many conditions,
including disorders of the liver, kidneys, or blood, may not be detected unless blood testing is performed. The
medications that we use to sedate animals and induce anesthesia are eliminated from the body primarily through
the liver and kidneys. Undetected diseases of these organs can increase the risk of anesthesia and prolong your
pet's recovery. For these reasons, we require blood screening before such procedures. Our laboratory is fully
equipped and staffed to perform these important blood tests. Results will be available for review prior to
anesthesia.
Please indicate your choice below:
( ) Intermediate Screen - Recommended for healthy patients less than 8 years of age, includes Albumin, Alk
Phos., ALT, BUN, Creatinine, Glubulin, Glucose, Total Protein and a Complete Blood Count. $62.00
( ) Comprehensive Screen - Recommended for patients 8 years of age and older, and those of questionable
health. Includes all of the above plus complete blood count, albumin, globulin, AST, total bilirubin, amylase,
cholesterol, calcium, and phosphorus. $104.00
( ) Feline Leukemia and Immunodeficiency Virus Testing (cats only) - Recommended for all cats that have
not been recently tested. $62.00
We also offer the HOME AGAIN microchip. It is about the size of a grain of rice and is inserted under the
skin. It is a permanent identification that can not be lost or changed. In the event that your pet should be lost or
stolen, a shelter or veterinarian can use a scanning device to identify your pet. Please ask the receptionist for
details. - Cost: $56.00
( ) Yes
( ) No
( ) Already has
I have had explained to me and consent to the anesthetic procedure which my pet is about to undergo. I
understand that no guarantee has been or can be made as to the result or cure that may arise. I understand that
there are inherent risks with any anesthetic procedure. I have been advised of the risks involved with the
anesthesia and surgery recommended for my pet.
I agree to pay, in full, for services rendered, including those deemed necessary for medical or surgical
complications or unforeseen circumstances. This includes the administration of emergency medications and the
performance of procedures such as CPR. I have read the above conditions of this hospital and acknowledge
receipt of this form.
I also acknowledge receipt of the form entitled “Anesthesia Information”.
Owner:<first-name> <last-name> Patient:<animal>
X____________________________________________
Procedure________________________
date____________________
Please list phone numbers where you can be reached in the event that a doctor needs to speak to you. Doctor's
calls normally occur between 7:30 am and 2:00 pm on the day of surgery.
___________________________
primary
phone #
___________________________
secondary
___________________________
other
SARATOGA VETERINARY HOSPITAL
ANESTHESIA INFORMATION
Like you, our greatest concern is the safety and well being of <animal>. We continuously scrutinize our
anesthesia protocol to provide the safest possible anesthesia experience. We also try to provide the shortestacting medications so that recovery will be speedy. A general overview of our anesthetic procedures and safety
precautions follows. If you have any questions, please feel free to ask any one of our staff members.
Before undergoing anesthesia, all patients will be given a complete physical examination and will have blood
drawn for pre-anesthetic testing. Our goal is to pinpoint any medical conditions that could affect the safety of
the anesthesia and/or surgery. Owners will be advised of any additional risks or changes that will be made to
maintain our high standards for safety. Ideally, all patients will be fasted for 12 hours prior to undergoing
anesthesia.
All patients will be maintained under anesthesia using SevoFlo. SevoFlo has been used in human medicine
since 1995. It is recommended for use in infant and pediatric surgery, a testament to its safety and
effectiveness. SevoFlo enters and exits the body very rapidly, allowing us good control during the procedure
and assuring a high degree of safety. Thanks to its rapid action, SevoFlo allows your pet to wake up faster and
return home sooner than other anesthetics.
All anesthetized patients will be monitored by two or more of the following: heart rate, respiratory rate, blood
oxygen level, carbon dioxide level in expired breath, core body temperature, and blood pressure.
Because stress and discomfort can significantly affect anesthesia and recovery, all animals will be sedated prior
to anesthesia. Butorphanol, a potent pain medication, will be administered to all pets prior to anesthesia. Some
patients will also receive local nerve blocks to decrease sensation during recovery. Pets may be given
additional medication during their recovery at the discretion of the veterinarian. Some patients will receive oral
analgesics for their owners to administer at home.
Placement of an intravenous catheter and administration of fluids during anesthesia helps maintain hydration
and proper blood pressure. It also allows us to administer medications more quickly in case of an emergency.
A small patch of hair must be shaved from one leg for this procedure. An IV catheter is required for all patients
undergoing anesthesia.