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Informed Consent for Methoxyflurane Sedation

Informed Consent for Methoxyflurane Sedation

You should inform your dentist if you are taking any medications. Particular antibiotics can increase the risk of methoxyflurane to the kidneys. These medications include tetracycline, gentamicin, kanamycin, colistin, polymyxin B, cephaloridine and amphotericin B. Interaction with -blockers also exist, which may cause hypotension.

You should inform your dentist if you are pregnant or breastfeeding. Methoxyflurane can cross the placenta, and pose Central Nervous System and respiratory depression risks for compromised foetuses. Methoxyflurane can be passed to the baby through the breast milk.

If you have any of the above, you may still be able to use Methoxyflurane, but your dentist will need to assess the risks against the potential benefits.

Potential Complications
Methoxyflurane is well tolerated, but it may occasionally have unwanted side effects. All medicines can have side effects. Tell your dentist as soon as possible if you do not feel weel after you have taken Methoxyflurane.
Methoxyflurane may cause:
• Nausea
• Drowsiness
Methoxyflurane sometimes causes:
• Coughing (usually in the first few breaths)
• Vomiting
• Dizziness
• Mild amnesia
• Dislike of characteristic fruity smell
• Fever
• Headache
Methoxyflurance rarely causes:
• Liver toxicity
• Kidney failure
Contact your doctor immediately if:
• You experience any symptoms of liver problems, such as loss of appetite, nausea, vomiting, jaundice (yellowing of the skin and/or eyes), dark coloured urine, pale coloured stools, pain/ache or sensitivity to touch in your right abdominal area (below your ribs).
• You experience any symptoms of kidney problems such as reduced urination or swelling of feet or lower legs.

There are certain medical conditions that contraindicate the use of Methoxyflurane. These include:
• Malignant hyperthermia
• Kidney problems
• Liver problems
• Allergy to inhalational anaesthetics.

Alternative Treatment Options
Other options for sedation include:
• Oral sedation (e.g. benzodiazepines)
• Other inhalation sedation (e.g. Nitrous Oxide)
• Intravenous sedation
• General anaesthetic
The dentist can provide you with more information on these sedation modalities.

The cost of administering Methoxyflurane treatment is as outlined in the attached treatment plan. Full payment is required on the day the appointment.

• I have read and understand the conditions and information in this Consent Form.
• I have discussed the information contained in the Consent Form concerning treatment under Methoxyflurane with my dentist.
• I have had explained to me the cost of the treatment and I accept responsibility for that cost.
• I authorise my dentist to provide me with treatment under Methoxyflurane.