Dental Anesthesia Consent

 Risks, Benefits, and Alternatives to Dental Anesthesia

Patient safety during anesthesia is our primary concern. While dental anesthesia is quite safe, serious and negative outcomes are rare and should not be expected, but they do occur.

Dental anesthesia can improve comfort, reduce anxiety, and allow necessary dental treatment to be completed safely and effectively. Risks are uncommon but may include, but are not limited to: nausea, vomiting, drowsiness, allergic and allergic-like reactions, breathing difficulties, changes in blood pressure or heart rate, injury to teeth or soft tissues, bruising, phlebitis (inflammation of a vein) or, in rare cases, more serious complications including brain damage or death. In extremely rare situations emergency transport and hospitalizations may be required such as in situations of aspiration, arrythmias, severe allergic and allergic-like reactions to medications.

Anesthesia can impair judgment and reaction speed. It is important to not make important decisions, sign important documents, operate machinery including vehicles and tools for 24 hours after receiving anesthesia. Due to potentially additive or synergistic effects of medication and alcohol consumption with anesthetics it is necessary to refrain from alcohol and recreational drugs for 24 hours after receiving anesthesia. Alternatives to anesthesia include proceeding with dental treatment using only local anesthesia (numbing injections), oral or inhaled sedation, behavioral or relaxation techniques, delaying treatment, or declining anesthesia altogether; however, these options may provide less comfort or may not be suitable for all patients or procedures.

Pregnancy: Anesthetics, anesthesia, medications, and drugs may be harmful to the unborn child and may cause birth defects or spontaneous abortion. It is imperative to rule out pregnancy prior to undergoing anesthesia. If you are or may be pregnant, it is of utmost importance to notify the anesthesia team. Pregnancy will require delay in anesthesia until after pregnancy.

Breast Feeding: Breastfeeding can generally be safely continued after anesthesia, as most anesthetic agents transfer into breast milk in clinically insignificant amounts. The American Society of Anesthesiologists recommends that infants fast from breast milk for 4 hours before elective procedures requiring anesthesia, while lactating mothers can typically resume breastfeeding as soon as they are awake and alert enough to hold the infant after receiving anesthesia.

Monitoring and Safety

Throughout your anesthesia care, your Certified Registered Nurse Anesthetist (CRNA) from Pathways Anesthesia, LLC will be present for the entirety of the procedure and continuously monitor oxygen levels, breathing and airway, heart rate and rhythm, blood pressure, level of sedation and response to anesthesia. Advanced anesthesia monitors and equipment, adhering to requirements by the state of Colorado, the American Association of Nurse Anesthesiologists and American Society of Anesthesiology will be present and patient’s vital signs and response to anesthesia will be monitored throughout the procedure.

Emergency equipment and medications are immediately available to manage rare complications.

What Will I Experience?

During anesthesia you may feel relaxed or sleepy. You may fall asleep completely. You will likely not feel pain. Many patients remember little or none of the procedure. After anesthesia you may feel drowsy, groggy, dizzy, or nauseated. You may have temporary memory gaps. A sore throat or mild headache may occur. Most effects wear off within several hours, though some drowsiness can persist into the next day. You must be supervised by a responsible adult for 24 hours and must not drive, make important decisions, or operate machinery during this time.

What Medications May Be Used?

Depending on your needs, your anesthesia provider may use medications such as: Propofol – induces sleep; Midazolam – reduces anxiety and causes amnesia; Fentanyl – provides pain control; Ketamine – helps manage pain and sedation; Dexmedetomidine – promotes calm sedation; Local anesthetics – numb the surgical area; Not all medications are used for every patient. Medications other than those listed may be necessary.

The goal of anesthesia is to:

• Keep you safe
• Control pain and anxiety
• Allow your dental care to be performed comfortably
• Provide the most appropriate sedation or anesthesia based on your health needs

Your Participation

To ensure your safety you must provide accurate medical information, report all medications and allergies, follow fasting (NPO) instructions exactly, and arrange for a responsible adult to drive you home and stay with you after the procedure

Failure to follow instructions may require cancellation of your procedure for safety reasons. Failure to timely, accurately and factually disclose information could result in serious harm to you.

Patient Privacy & HIPAA Compliance Statement

Pathways Anesthesia, LLC is committed to protecting the privacy and security of your personal health information ("Protected Health Information" or "PHI") in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

We may use and disclose your PHI only as permitted by law for the following purposes:

• Treatment: To provide, coordinate, or manage your anesthesia and related healthcare services.
• Payment: To obtain payment for medical services provided (insurance billing, claims processing, etc.).
• Healthcare Operations: For quality assessment, accreditation, training, credentialing, and business operations necessary to provide care.

Additional disclosures may occur when required or permitted by federal or state law, including public health reporting, health oversight activities, emergency situations, safeguarding against threats to safety, or lawful requests by regulatory authorities.

Your Rights Under HIPAA

You have the right to:

• Access your medical records and request copies.
• Request corrections to inaccurate or incomplete records.
• Restrict certain uses or disclosures of your PHI (subject to legal
• allowances).
• Request confidential communication methods (such as alternate email/phone contact).
• Receive a list of disclosures made for purposes outside routine treatment, payment, or operations.
• Receive a copy of the complete HIPAA Notice of Privacy Practices upon request.
• File a privacy complaint if you believe your privacy rights have been violated, without fear of retaliation.

Safeguards of Your Information

Pathways Anesthesia, LLC uses administrative, physical, and electronic safeguards to protect PHI, including secure encrypted electronic communication platforms such as Hushmail for signature and patient document transmission.

Contact Regarding Privacy Rights

Questions or concerns regarding your privacy rights or this notice may be directed to the Privacy Officer at:

Pathways Anesthesia, LLC

(Official contact details available upon patient request.)

HIPAA Acknowledgment & Consent

I acknowledge that:

• I have received and reviewed the HIPAA Notice of Privacy Practices for Pathways Anesthesia, LLC.
• I understand how my protected health information may be used and disclosed as described above.
• I understand my rights regarding access to and control of my health information.
• I agree that my PHI may be used and disclosed for treatment, payment, healthcare operations, and other lawful purposes.
• I understand that electronic communications and signatures include secure, encrypted delivery methods.