Anesthesia consent
Client:_____________________________ Pet:_______________________________Date:___________
Procedure Planned:____________________________________________________________________

Anesthesia is required to perform the dental, surgical, or diagnostic procedure that has been recommended for your pet.

We take many steps to make anesthesia as safe as possible for your pet. We perform an exam and appropriate tests
prior to anesthesia to assess your pet’s risk and to determine if any special precautions need to be taken. We place an
intravenous catheter prior to anesthesia so that fluids and any emergency medications can be given as needed. A
breathing tube is placed to ensure proper delivery of oxygen and anesthetic gases and to reduce the risk of aspiration.

During anesthesia, we monitor your pet closely with the help of monitors that measure heart rate, respiratory rate,
oxygenation, blood pressure, and temperature. We use warm air blankets to keep our patients warm during anesthesia.
We adjust anesthetic levels during the procedure so that we are using only as much as needed to keep our patients
comfortable and safe. Pain medications and medications for anxiety are given before and after each procedure and we
monitor our patients closely to ensure that any pain is well controlled.

After anesthesia, we watch each patient closely to ensure that he or she is comfortable and will sit with or hold patients
who need reassurance and comfort. We perform a very small number of procedures each day so that each patient can
receive our focused attention.

Even when every possible precaution is taken, complications, often unexpected, can occur with anesthesia, even in
healthy patients. The risk of anesthetic complications is highest in patients who are ill or seriously injured. Other
patients who may be at higher risk for complications are very young patients, very old patients, very tiny patients, and
patients with breed related airway compromise (such as English Bulldogs, Pugs, and other very short faced patients).

Complications associated with anesthesia can include low blood pressure, low body temperatures, low heart rates,
decreased breathing, irregular heart rhythms, regurgitation, and severe confusion/agitation when waking up. In most
cases, these complications are manageable and do not cause any lasting effects. However, in very, very rare situations,
anesthetic complications can lead to severe complications (including aspiration pneumonia, blindness, seizures,
esophageal strictures, kidney damage, etc) or even death. We will do everything we can to protect your pet from
complications during and after anesthesia, but there is still a risk of complications associated with any anesthetic
procedure.

By signing below you are acknowledging that you understand the risks associated with anesthesia, have had any
questions or concerns addressed, and consent to anesthesia for your pet.
Client______________________________________________ Date_______________
© 2014 Sunset Pet Hospital
Surgery only
Surgical procedures also always carry some risk of complications. The risks will vary depending on the surgery. The most
common complications associated with surgery are bruising, swelling, or infection of surgical incisions. These
complications can be decreased by restricting your pet’s activity after surgery and preventing scratching and licking at the
incision. Other surgical complications can include excessive bleeding, potentially life threatening in rare cases, and
unintended injury to tissues or organs in or near the surgical site.

Please ask us for information about specific risks associated with your pet’s planned surgery if you feel this has not been
fully addressed to your satisfaction.

Please initial below to indicate you are consenting to the described surgery, understand the risks, understand no
guarantees of outcome have been given, and have had any questions answered to your satisfaction:__________
Dental procedures onlyExtractions known to be needed? Yes ___

Extractions are only performed when we believe the risk of leaving a diseased tooth in place clearly exceeds the risk of
complications. Leaving a badly diseased tooth in place will often cause pain, persistent infection and inflammation, and
gradual damage to the soft tissues and bones in the mouth and jaw as well as occasionally damage to the eye, nose, and
distant organs such as the kidneys, liver, and heart.

When dental extractions are performed, there is a risk of complications, including bleeding, incomplete removal of the
tooth roots, and, rarely, damage to the eyes, nose, nerves, or jaw.

We may refer you to a dental specialist for an extraction if we feel that a needed procedure would be much safer if
performed by a specialist or if a root canal is a better option than extraction.

At Sunset Pet Hospital all extractions are performed by the veterinarian, in keeping with the recommendations of the
American Animal Hospital Association and the American Veterinary Dental Society.

In many cases, we do not know if extractions are needed or how many are needed until we have performed a dental
exam and x-rays under anesthesia. We will always attempt to contact you at this time to let you know what extractions
are needed and to discuss any questionable teeth. If we are unable to immediately reach you at that time, we need to
know how you wish us to proceed. Therefore, please initial one of the below*____ Proceed with any needed extractions, that the veterinarian feels is appropriate. I
understand that if the veterinarian feels that a tooth or teeth would be better treated
by a specialist, they will not be extracted unless discussed specifically with me first and
that an additional procedure with a dental specialist may be recommended. I
understand the risks associated with dental extractions and that extractions are only
recommended when the risk of leaving the tooth in place is believed to exceed the risk
of extracting it.
*____ Do not perform any extractions until you speak with me directly. I understand
this may mean that my pet will need an additional anesthetic procedure at additional
cost if I am not available at the phone number I have provided when I am called. I
understand that leaving a badly diseased tooth in place can lead to ongoing infection,
inflammation, and pain, as well as potentially dental abscesses, jaw fractures and/or
damage to vital organs.
© 2014 Sunset Pet Hospital