英文麻醉知情同意书

THE ANAESTHESIA AGREEMENT (To be signed by the patient himself,or the responsible officer before operation) Name of patient: Age: years Sex:male/female ID number(if applicable): Nationality: Name of organization: Diagnosis: Operaion: Anesthesia: The anaesthetist will take responsibility of the anaesthesia.But the patient will still be under the risks of anaesthesia complications and accident. 1.Respiration/heartbeat suddenly stop induce death. 2.Postoperative Headache.or Shivering.Urinary retention. 3.Extradural haematoma spinal cord injury induce paraplegina. 4.Transverse myelitis and cauda equine syndrome. 5.Nausea/vomiting induce Respiratory depression. 6.Hemorrhagic shock. 7.Neurological complications(cognitive handicap). 8.Cardiovascular complications induce of arrhythmias and hypertension,cardiac arrest. 9.Medicine hypersensitivity-allergic;idiosyncratic-genetic;cardiac arrest If you understand it,and agree to anaesthesia,you should sign your full name here.Also we need the agreement of your contingent chief who should be in charg of you . Patient's signature: Commander's signature Date: