Informed consent for moderate or deep procedural sedation administered by the procedural team (not anesthesiology), covering drug classes, airway risks, monitoring requirements, and pre-sedation screening.
The Procedural (Moderate/Deep) Sedation Informed Consent is a ready-to-use healthcare & wellness template you can send for signature in minutes. It is written for 1 signer (patient) and, by default, expires 30 days after it is sent if left unsigned. It covers consent, sedation, anesthesia, procedural sedation, healthcare. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.
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# Procedural (Moderate/Deep) Sedation Informed Consent > **Important — not medical advice.** For use by a licensed provider; tailor risks/benefits/alternatives to the patient and your institution's protocols and state law. **Patient Name:** ___________ **Date of Birth:** ___________ **Medical Record Number:** ___________ **Physician Administering or Supervising Sedation:** ___________ **Procedure for Which Sedation Is Requested:** ___________ **Scheduled Date:** ___________ **Anticipated Sedation Level:** ___________ --- ## 1. Description of Procedural Sedation Procedural sedation is the administration of sedative, analgesic, and/or dissociative medications to allow a patient to tolerate a diagnostic or therapeutic procedure with reduced anxiety, pain, and discomfort, while maintaining protective airway reflexes and cardiorespiratory function. It is administered and monitored by the procedural team (not general anesthesia). **Levels of sedation:** - **Minimal sedation (anxiolysis):** Reduced anxiety; normal responsiveness to verbal commands; airway and protective reflexes fully intact - **Moderate sedation (conscious sedation):** Reduced level of consciousness; purposeful response to verbal commands or light touch; airway and protective reflexes maintained; no interventions required to maintain ventilation - **Deep sedation:** Reduced consciousness from which the patient is not easily aroused; may not respond purposefully to stimulation; may require assistance to maintain a patent airway; spontaneous ventilation may be inadequate; cardiovascular function is usually maintained There is a continuum between sedation levels; a patient may move from the intended level into a deeper level. The sedation team is trained to manage this continuum. **Medications commonly used:** - **Benzodiazepines** (e.g., midazolam [Versed]): reduce anxiety and produce amnesia - **Opioid analgesics** (e.g., fentanyl, morphine): reduce pain perception - **Propofol:** rapid-onset sedative-hypnotic capable of producing moderate or deep sedation; no analgesic properties - **Ketamine:** dissociative agent with analgesic and amnestic properties; maintains airway reflexes; may be used in combination with other agents