Is Sedation Consent the Same as Anesthesia Consent?

By Vanessa A. Olbrecht, MD, MBA, FASA

Informed consent is one of the most important concepts in medicine. During the process, the care team partners with a child and parents/guardians to provide information to them, enabling them to come to an appropriate decision about proceeding with care. By creating this partnership, the consent process may decrease the risk of litigation. However, to be successful, consent involves engaging individuals capable of making care decisions, providing the relevant information that includes the risks and benefits of the specific care, and allowing those individuals to make a decision without any type of undue pressure or coercion. Some have argued that it is impossible for true informed consent to ever happen as patients and families are often unable to fully understand all the information presented. Therefore, it falls upon the medical provider to present all the relevant and important information rather than a full disclosure of all possibilities. But how do you decide and what to you say? When obtaining consent for sedation, is this the same as obtaining consent for general anesthesia? The following are my thoughts, but I look forward to reading your thoughts in the blog comments below!

1. You have a duty to disclose all important information in non-emergency situations.
One of the most important components of the informed consent is enabling patients and families to understand the most common risks but also to inform them of possible severe risks. When it comes to pediatric sedation, some of the more common things we see are nausea, vomiting, emergence delirium, and failure of the sedation. Although it is theoretically possible for a planned sedation to go awry and lead to terrible outcomes such as death or severe neurological injury, these events are thankfully quite uncommon, particularly with providers practicing within their scope. As such, as the provider, you should focus on the most common as well as some of the greatest risks of the sedation.

2. It is important to recognize and assess what level of sedation the patient may need and tailor the discussion to be relevant to the individual patient.
We have all seen the 5-year-old patient coming in for an MRI that is consented for general anesthesia but then shows signs of being able to do the scan without any type of sedation at all. We have also seen the opposite scenario in which a 15-year-old is planned undergo an MRI with no sedation and requires general anesthesia. As a sedationist, it is important to assess each individual patient, including temperament, history, etc. and to partner with other team members to engage all appropriate resources to help that patient through whatever procedure he or she is having with the least amount of sedation. As this assessment is being made, the discussion of informed consent will revolve around the level of sedation that you expect for that particularly patient. So, for example, if you feel that one dose of midazolam will suffice, then perhaps a discussion about deep sedation may not be relevant. However, if you are planning a moderate sedation, then the conversation may be much more warranted.

3. Recognize that all good plans do not always lead to success and sedation lies along a continuum.
Regardless of what your pre-sedation assessment it, sedation lies along a continuum, from minimal sedation/anxiolysis all the way to general anesthesia. Of course, even the best laid plans sometimes go wrong. Thus, it is important, as part of the consent discussion, to make patients and families aware that while you plan for a certain type and level of sedation, patients do not always cooperate and may end up deeper than originally intended. At that point, as a sedationist, you must bring that patient back to the appropriate plane of sedation. This discussion is important, but perhaps all the consequences of general anesthesia are not as important. What are your thoughts? Let’s continue the discussion below!