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Hours 235 Hopmeadow Street
Simsbury, CT 06089

Approval for Anesthesia/Sedation

Patient*

Date*

There is always some risk associated with an anesthesia or sedation procedure. At Hopmeadow Animal Hospital we believe strongly in making any anesthetic procedure as safe as possible for the patient. We choose the safest anesthetic drugs possible for the patient and provide extensive monitoring while the patient is under anesthesia (heart rate, respiratory rate, blood pressure, telemetry, temperature, capnography, etc). Complications occur very rarely but can include:

Tracheal irritation/cough following the procedure

Pneumonia

Tracheal tear

Skin irritation associated with IV catheter placement

Worsening of underlying disorders such as kidney disease

Unmasking of systemic disease

Unexpected reactions to anesthetic agents

Thermal burns

Organ failure (kidney, liver, heart)

Blood loss

Death
Consent for Cardiopulmonary Resuscitation (CPR)*

YES: I would like CPR to be performed on my pet if my pet passes away and I understand that this would incur additional charges.

NO: DNR - Do Not Resuscitate

I acknowledge that I am the owner/authorized agent for this pet. I have read and understand the risks for anesthesia and give my consent for the staff of Hopmeadow Animal Hospital to perform anesthesia/sedation on this pet.*

Printed Name

Hopmeadow Animal Hospital