Four full pre-anesthesia consent notes produced by an ambient AI scribe running the
six-section structured prompt. Each one shows the same six sections carrying a different conversation.
From the poster Augmenting Pre-Anesthesia Consent Documentation With AI: A Two-Cycle
PDSA Quality Improvement Project.
Alfredo Camargo Rodrigues, MD · Bryan S. Brindeiro, MD · James M. Blum, MD
Department of Anesthesia and Health Care Information Systems, University of Iowa Health Care, Iowa City, IA
Every example on this page is invented.
The authors wrote these notes as synthetic composites for display. The clinical situations, the ages, the
histories, the questions and the quoted words are all fabricated. No real patient appears here, and no real
note was masked or edited to produce them. What is faithful is the shape: the six sections, their order, and
the level of detail the tool produces in practice.
Why the shape matters
A consent record has to carry the same elements every time. An ambient scribe left to itself produced a
different shape at every encounter, which made the record unpredictable and kept other providers from adopting it.
The six-section prompt fixes the shape. The conversation still varies from patient to patient, and that variation
is exactly what these four examples show: the same headings, filled with four very different encounters.
45-year-old man with coronary disease and a prior lumbar fusion, seen for pre-anesthesia evaluation before atrial flutter ablation.
He raised being awake during the procedure as his main worry, and referred back to a previous general anesthetic where he woke groggy and disoriented.
He asked directly how long he would need to lie flat, and said the immobility troubles him more than pain does.
He asked about the anesthetic plan and about comfort measures, and he asked to use the bathroom before going in.
ANESTHESIA PLAN
Monitored anesthesia care with moderate sedation. He stays awake, interactive and able to speak throughout.
Sedation titrated to keep him comfortable and a little sleepy while still responsive. He should expect to remember much of the procedure.
Local anesthetic at the access sites. No regional block and no systemic local anesthetic beyond the standard infiltration.
Two peripheral intravenous lines, one already in place and a second to be placed, for fluids and medication. Oxygen by nasal cannula.
The plan is personalized to his paroxysmal arrhythmia. Full general anesthesia would suppress the rhythm and make mapping harder.
RISKS DISCUSSED
General anesthesia can suppress the arrhythmia and hinder mapping, which risks an incomplete ablation.
Discomfort from lying still for a prolonged period, and unusual sensations in the legs during catheter manipulation.
If he becomes significantly distressed or cannot tolerate the procedure, the team can deepen sedation, and that increases the chance the ablation does not succeed.
PATIENT UNDERSTANDING AND CONSENT
Risks, benefits and alternatives explained in detail.
He demonstrated understanding, asked questions, and the team addressed every concern he raised.
He agreed to proceed with the monitored anesthesia care approach.
EXPECTATIONS AND NEXT STEPS
Use the bathroom before the procedure to minimize interruptions.
Transfer to the procedure room, monitors applied, positioned supine on a narrow bed with arms at the sides.
The procedure is scheduled for about four hours and may run shorter if the focus is identified quickly.
Recovery phases explained, and nursing staff will be available throughout.
ADDITIONAL RELEVANT POINTS
No additional procedures planned beyond the described intravenous access and nasal oxygen.
His discomfort from earlier prolonged procedures was validated. Immobility, rather than pain, is his main challenge.
The team emphasized a collaborative partnership and encouraged him to report any symptom or intolerance during the procedure.
2
GENERAL ANESTHESIA
Cholecystectomy
30-year-old man, former smoker, obesity, sleep apnea, asthma
INTERACTION SUMMARY
The anesthesiologist reviewed the chart and recent history before meeting him. Nothing in the review substantially raised his perioperative risk beyond his known conditions.
He participated actively, asked about pain control after the operation, and stated a clear preference for the intravenous line on his left side.
He explained that intravenous insertion is typically the worst part of surgery for him. The team allowed him to look away and maintained his modesty during bed preparation.
He voiced understanding and said he felt ready for surgery.
ANESTHESIA PLAN
General anesthesia with intravenous access established before entering the operating room.
Monitors applied, then anesthetic medication given to induce sleep and unconsciousness.
A personalized approach to pain control, using multimodal analgesia and opioids during and after the operation.
The plan reflects his comorbidities and the surgical procedure.
RISKS DISCUSSED
General anesthesia risks reviewed, including allergic reaction, heart attack, stroke, death, and the need for intubation with possible dental injury and sore throat.
Postoperative nausea and vomiting discussed, noted as not markedly elevated for him but relevant because the surgery is abdominal.
Postoperative pain explained, especially given the incision, with reassurance that the team will manage the pain even though it cannot be promised to be absent.
PATIENT UNDERSTANDING AND CONSENT
Risks, benefits and alternatives explained.
He demonstrated understanding, asked questions, and the team addressed all his concerns.
He agreed with the anesthesia plan and the next steps.
EXPECTATIONS AND NEXT STEPS
Intravenous placement before the operation, on the left side, following his stated preference.
Transfer to the operating room, identity and procedure verification, monitors applied, then induction of anesthesia.
He should expect amnesia for events during the operation, waking in the operating room, then transfer to the recovery room for full consciousness and pain management.
A multimodal pain strategy is in place, including acetaminophen before surgery and anticipated discharge medication.
ADDITIONAL RELEVANT POINTS
No new allergies, acute symptoms or logistical barriers identified.
Staff ensured his comfort and modesty during preparation.
His preference to look away during line placement was accommodated.
3
SPINAL WITH SEDATION AND NERVE BLOCK
Total knee arthroplasty
66-year-old woman, hypertension, type 2 diabetes, prior spinal anesthetic that she recalls well
INTERACTION SUMMARY
66-year-old woman seen before a right total knee arthroplasty. She had a spinal anesthetic for a previous operation and remembers it clearly.
She asked whether she would hear the surgery, and said the sound was what unsettled her last time.
She asked how soon she could stand afterward, explaining that she cares for her husband at home and wants to return to that quickly.
She asked whether the nerve block would leave her leg weak.
ANESTHESIA PLAN
Spinal anesthetic for the operation, with sedation titrated so she can rest and stay unaware of the room.
An adductor canal block for pain after surgery, chosen because it spares much of the quadriceps strength she needs to stand early.
Music through headphones offered, which addresses her concern about hearing the procedure.
Intravenous access before entering the operating room.
RISKS DISCUSSED
Spinal anesthesia risks reviewed, including a drop in blood pressure, headache after the procedure, and difficulty passing urine.
Nerve block risks reviewed, including temporary weakness, bruising at the site, and a small risk of lasting nerve irritation.
The possibility that the spinal does not provide adequate anesthesia and the team converts to general anesthesia during the operation.
General risks of sedation explained, including breathing depression requiring support.
PATIENT UNDERSTANDING AND CONSENT
Risks, benefits and alternatives explained, including the option of general anesthesia instead of a spinal.
She restated the plan in her own words, including why the block was chosen to protect her strength.
She asked questions, the team addressed them, and she agreed to the plan.
EXPECTATIONS AND NEXT STEPS
Intravenous placement, block performed before the operation with monitoring, then transfer to the operating room.
Positioning for the spinal explained, along with what she will feel during placement.
Sedation begins once the spinal is working. She should expect to rest through the operation.
Recovery room, then return of leg sensation over several hours, with physical therapy planned the same day.
ADDITIONAL RELEVANT POINTS
Her role as a caregiver at home shaped the choice of block and the early mobility plan.
She was reassured that headphones and sedation together address her concern about hearing the room.
4
MONITORED ANESTHESIA CARE
Cataract extraction, discussion with a legally authorized representative
79-year-old woman with moderate dementia, atrial fibrillation, accompanied by her daughter who holds healthcare power of attorney
INTERACTION SUMMARY
79-year-old woman with moderate dementia seen before cataract extraction, accompanied by her daughter, who holds healthcare power of attorney.
The anesthesiologist spoke with both of them. The patient answered simple questions and said she wanted to see better to read her mail.
Her daughter asked how the team would keep her calm without a medication that worsens her confusion afterward.
Her daughter asked to stay with her until the procedure begins.
ANESTHESIA PLAN
Monitored anesthesia care with minimal sedation, chosen deliberately to reduce the chance of postoperative confusion.
Topical and local anesthesia to the eye placed by the surgical team.
Reassurance and a familiar voice used in place of deeper sedation wherever possible.
Her daughter will stay with her in the preoperative area until transfer.
RISKS DISCUSSED
Sedation can worsen confusion after the procedure, which is why the team plans to keep it minimal.
The need to lie still and the possibility of feeling pressure around the eye.
If she cannot stay still, the team may need to deepen sedation, which raises the risk of confusion afterward.
General risks of sedation explained, including breathing depression requiring support.
PATIENT UNDERSTANDING AND CONSENT
Risks, benefits and alternatives explained to the patient in simple terms and to her daughter in full.
The patient indicated she understood she would be awake and that her eye would feel numb.
Her daughter demonstrated understanding, asked questions, and the team addressed each one.
Her daughter consented as the legally authorized representative, and the patient assented.
EXPECTATIONS AND NEXT STEPS
Intravenous placement, monitors applied, then transfer to the procedure room with her daughter present until the door.
The procedure is short. She should expect light pressure and bright light rather than pain.
Recovery in the same area, with her daughter brought back as soon as she is settled.
Discharge home the same day with written instructions given to her daughter.
ADDITIONAL RELEVANT POINTS
The plan to minimize sedation was driven directly by her daughter's concern about postoperative confusion.
Her stated reason for wanting the surgery, reading her mail, was recorded because it reflects what she values.