SARATOGAVETERINARYHOSPITAL
ANESTHESIA RELEASE FORM
File# ______Date ______
Before placing ______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. $74.00
( ) 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. $114.00
( ) Feline Leukemia and Immunodeficiency Virus Testing (cats only) - Recommended for all cats that have not been recently tested. $79.50
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: $60.00
( ) 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: ______Patient: ______
Procedure______
X______Date______
Signature
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.
______
primaryphone # secondary other
SARATOGAVETERINARYHOSPITAL
ANESTHESIA INFORMATION
Like you, our greatest concern is the safety and well being of your pet. We continuously scrutinize our anesthesia protocol to provide the safest possible anesthesia experience. We also try to provide the shortest-acting 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.