INSTRUCTIONS FOR OUTPATIENT IV SEDATION


You have elected to have intravenous sedation for a dental/surgical procedure. A catheter will be placed in a vein in your arm or hand. Drugs will be administered making you relaxed, sleepy and even causing some level of amnesia. You will not be unconscious. Local anesthetics may be used in addition to control pain during surgery. Because of your sedated condition, you must adhere to the following recommendationsfor your safety and recovery:

  1. Your medications will prevent you from moving unattended and from driving; therefore, we require that you be accompanied by your escort who is responsible for your care following your procedure. If you do not come with a responsible escort, your appointment will becancelled.
  2. Your escort must be present when checking in for the procedure and when finished so that you may be discharged to go home immediately following your recovery. This escort must remain with you for 8 hours to provide or seek help if needed.
  3. DO NOT EAT for 8 hours prior to surgery. You may have clear liquids (water, Gatorade, sprite, black coffee w/no cream, apple juice) up to 2 hours prior to surgery.
  4. Do notbring your children
  5. Wear comfortable, loose fitting clothing. Avoid nail polish/fake nails/make-up; if possible. Please do not wear contact lenses; if possible.
  6. DO NOT consume any alcoholic beverages within 24 hours before or after surgery.
  7. Be sure to advise us of any medications or pills you are taking including aspirin or birth control pills.Take your regular medications as scheduled unless otherwise advised.
  8. DO NOT operate vehicles, handle a firearm, drink alcohol, or sign legal documents for at least 24 hours after surgery and while taking your post-op narcotic pain medications if prescribed.
  9. Females: Please update us concerning potential pregnancy or recent positive pregnancy tests.

I understand my responsibilities as listed above. I agree to adhere to my responsibilities as a patient.



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CONSENT FOR OUTPATIENT IV SEDATION


I, , acknowledge that Dr. Jonathan Pluid has explained to me that I will have a dental procedure performed under IV moderate sedation. By definition, IV moderate sedation is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or by light, tactile stimulation.

It has been explained to me that all forms of anesthesia involve some risks and no guarantees or promises can be made concerning the results of my procedure or anesthesia. Although rare, unexpected complications can occur with sedation including: infection, bleeding, drug reactions, blood clots, loss of sensation, loss of limb function, paralysis, stroke, brain damage, heart attack or death. I understand that these risks apply to all forms of anesthesia and I give consent for Dr. Jonathan Pluid to perform IV moderate sedation.



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ESCORT RESPONSIBILITIES FOR OUTPATIENT IV SEDATION


Be present in the facility before and after completion of the operation: You are required to be present when checking the patient in for his/her procedure. Please be available during the entire procedure time should we finish early. The patient will be released to your care upon completion of the procedure and sufficient anesthesia recovery.

Don't allow the patient to drive: You will be required to drive the patient home and stay with them for a minimum of 8 hours post procedure. Patients who have had sedation should not drive for the rest of the day.

Please relay any post-opinstructions you received from the provider to the patient: The medications given will cause amnesia and they most likely will not remember any instructions given to them by our staff upon completion of the procedure.

I understand my assigned role and responsibilities as listed above. I agree to adhere to my responsibilities as a patient escort.



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