Valid Informed Consent to Sedation and Analgesia for Medical or Dental Procedures
Valid informed consent ( Appendix 3 ) is a complex process. The General Dental Council (GDC), UK, provides valuable principles and standards for the dental team regarding consent for dental procedures. 6 It should be documented that appropriate consent was obtained from the patient, or a responsible person (parent/caregiver), according to local and international requirements. Before the process c
Valid informed consent (Appendix 3) is a complex process. The General Dental Council (GDC), UK, provides valuable principles and standards for the dental team regarding consent for dental procedures.6 It should be documented that appropriate consent was obtained from the patient, or a responsible person (parent/caregiver), according to local and international requirements.
Before the process can be completed, information about the sedation and procedure must be provided in a clear and understandable way. This should happen at an appropriate time in order for the patient/parent/caregiver to be able to digest the information and formulate questions. The discussion should, therefore, if possible, not occur immediately before the procedure or even on the day of the procedure. Informed consent must never be obtained after the administration of sedative and analgesic drugs. The nature of the procedure to be performed may also not be changed after sedative and/or analgesic drugs have been administered to the patient.
Patients/parents/caregivers must understand the risks of sedation before consenting. Therefore, an explanation of the procedure, the proposed sedation technique and the risks and benefits of the proposed technique should be given. Patients/parents/caregivers must be aware of the possibility that the sedation may fail and that the procedure may have to be abandoned or performed under GA at a later date.
Alternatives to sedation (e.g. GA or local/regional anaesthesia) should also be discussed. Behavioural management techniques as an alternative to sedation, if relevant, should be discussed to ensure that the most suitable form of treatment is selected.
Consent must be obtained for both the procedure and the sedation. It is the responsibility of the SP to ensure that the patient/parent/caregiver understands the consequences of the decisions they are about to make. If the child is not legally competent to give consent (e.g. underage or a child with special needs), it will have to be obtained from someone with parental responsibility (i.e. the mother or father, or legal caregiver).
A more difficult question to answer is when can a child give consent for a procedure. According to the Medical Protection Society (MPS), a child of 12 years or older may consent to medical treatment. For surgical treatment, a child of 12 years or older may consent with a parent or guardian’s assent. The child must, however, have the maturity to understand the implications of the procedure.
As cited in the Southern African Journal of Anaesthesia and Analgesia,7 children can give consent in the following situations: (i) for medical treatment, if they are older than 12 years of age, and if they have the maturity and capacity “to understand the benefits, risks, social and other implications of the treatment” – this is independent of parents’ consent; or (ii) for surgical procedures, if they are 12 years of age and assisted by their parent or legal guardian (Form 34, or Form 35 if the child’s parents themselves are aged 18 years and younger).
The planned usage of suppositories or rectal medication must also be explained carefully to the parents and consent be obtained ahead of time.
SASA Paediatric Guidelines for the Safe use of Procedural Sedation and Analgesia for Diagnostic and Therapeutic Procedures in Children: 2021–2026