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This document is a consent form for patients undergoing spinal cord stimulator implantation and associated anesthesia, outlining the procedure details, risks, alternatives, and consent requirements.
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How to fill out consent for spinal cord

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How to fill out Consent for Spinal Cord Stimulator Implant and Administration of Anesthesia or Sedation

01
Read the consent form thoroughly to understand its contents.
02
Confirm your identity and the procedure you are consenting to (Spinal Cord Stimulator Implant and Administration of Anesthesia or Sedation).
03
Review the potential risks and benefits listed in the consent form.
04
Ask your healthcare provider any questions you may have about the procedure, anesthesia, or sedation.
05
Discuss any allergies or previous reactions to anesthesia with your healthcare provider.
06
Provide your medical history as requested in the form.
07
Sign and date the consent form indicating your informed consent to proceed with the procedure.

Who needs Consent for Spinal Cord Stimulator Implant and Administration of Anesthesia or Sedation?

01
Patients who are scheduled to undergo a spinal cord stimulator implant procedure.
02
Individuals who require anesthesia or sedation as part of their medical treatment.
03
Patients with chronic pain conditions seeking relief through spinal cord stimulation.
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Because the placement of SCS under general anesthesia precludes the use of intraoperative test stimulation, general anesthesia is not recommended [5]. Epidural anesthesia can be used to perform the SCS without discomfort if a cooperative patient can localize the area of paresthesia.
Most patients are able to return home the same day after their procedure. However, you may be required to stay in the hospital for a day or two to allow the medical team to monitor your recovery and adjust your medication as needed.
The lead's wires (electrode) are attached to an external generator worn on the belt. Spinal cord stimulator surgery is not painful for the average patient, although you may experience some temporary discomfort over the final implant site.
The reason why a psychological exam is part of the spinal cord stimulation process is because everyone responds differently when a device is implanted in their body. Some people may not respond well; it can cause increased worry and anxiety, which can reduce the effectiveness of the device.
I hereby consent to the anesthesia service checked above and authorize that it be administered by or his/her associates, all of whom are credentialed to provide anesthesia services at this healthcare facility. I also consent to an alternative type of anesthesia, if necessary, as deemed appropriate by them.
You will be asleep and pain-free with general anesthesia.
It's an outpatient procedure that usually takes 30-90 minutes. On the day of your procedure, you lie face down on an X-ray table. We apply local anesthesia along your spine, and we may give you a sedative medication to help you remain comfortable.
Electrode implantation can be performed either under a version of profound anesthesia (local anesthetic and intravenous sedation) which allows for awake intraoperative testing of the implant or under general anesthesia which precludes patient interaction during surgery.

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Consent for Spinal Cord Stimulator Implant and Administration of Anesthesia or Sedation is a legal document that confirms a patient's agreement to undergo the procedure of spinal cord stimulation and the administration of anesthesia or sedation. It ensures that the patient is informed about the risks, benefits, and alternatives before proceeding.
The patient undergoing the spinal cord stimulator implant procedure is required to file the consent form. It may also involve signatures from a legal guardian or representative if the patient is unable to consent for themselves.
To fill out the consent form, the patient or their representative should read the document carefully, fill in personal information such as name and date of birth, review and acknowledge the risks and benefits outlined, and provide a signature along with the date.
The purpose of the consent is to inform the patient about the procedure, ensuring they understand what it entails, confirm their voluntary decision to proceed, and provide legal protection for both the patient and the healthcare provider.
The information that must be reported on the consent includes the patient's personal details, a description of the procedure, risks associated with the surgery and anesthesia, benefits expected from the procedure, alternatives available, and a statement confirming the patient's understanding and voluntary consent.
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