(a)"High-risk patient" means a patient who has a level
3 or 4 classification according to the American Society of Anesthesiologists
Physical Status Classification System (ASA).
(b)For the purposes of this chapter, ASA classifications
are defined as follows:
(1)ASA I: a normal healthy patient
(2)ASA II: a patient with mild systemic disease
(3)ASA III: a patient with severe systemic disease.
(4)ASA IV: a patient with severe systemic disease
that is a constant threat to life.
(c)A permit holder may not administer sedation/anesthesia
under a level 2, level 3, or level 4 permit to a high-risk patient
unless the permit holder has:
(1)completed a university or hospital-based residency
at least 12 months in length; or
(2)completed a board-approved education program that
includes a minimum of sixteen (16) hours of didactic training and
instruction in sedation/anesthesia of high-risk patients. Successful
completion of the program must include passing an examination covering
the course components. Didactic education must include:
(A)pre-anesthetic patient assessment/evaluation for
medically compromised and geriatric patients;
(B)physical evaluation and medical history of high-risk
patients, including obesity, pregnancy, and obstructive sleep apnea
syndrome, cardiovascular disease, metabolic or genetic disorders,
hematologic disorders, and other systemic diseases/conditions affecting
sedation/anesthesia;
(C)high-risk patient anatomical and physiological
differences;
(D)medical consultations;
(E)high-risk respiratory assessment, including airway
anatomy, physiology, and management;
(F)informed consent by patient, parent, or guardian;
(G)sedation/anesthesia pharmacology;
(H)sedation/anesthesia management of patients identified
with special health care needs;
(I)high-risk patient monitoring;
(J)peri-operative complications and emergencies;
(K)emergency management of high-risk patients, including
high-risk anesthesia equipment and resuscitation supplies;
(L)sedation/anesthesia technique;
(M)sedation/anesthesia record keeping;
(N)patient recovery and discharge;
(O)appropriate patient selection; and
(3)completed satisfactory management of sedation/anesthesia
in at least ten (10) cases involving high-risk patients sedated/anesthetized
at the highest level of permit held. At least five (5) of the cases
must involve the hands-on administration of sedation/anesthesia as
the primary provider. No more than five (5) cases may be observed.
The ten (10) cases must involve either live patients and/or high-fidelity
emergency sedation/anesthesia simulations. All of the cases must be
performed and documented under the on-site instruction and direct
supervision of a licensed dentist authorized to administer sedation/anesthesia
to high-risk patients.
(d)A permit holder is authorized to administer sedation/anesthesia
under a level 2, level 3, or level 4 permit to a high-risk patient
if they have completed the requirements above. The permit holder must
attest to their advanced training in high-risk patients on their initial
and/or renewal permit application and they will be required to produce
proof of completion as part of a permit inspection or an investigation
of a complaint involving sedation/anesthesia of a high-risk patient.
(e)The education hours described in subsection (c)(2)
of this section can be applied towards the permit holder’s continuing
education requirement for maintaining a sedation/anesthesia permit.
(f)The didactic and clinical training described in
subsection (c)(2) and (3) of this section may not be fulfilled by
the same didactic and clinical training used to fulfill the requirements
for initial permit issuance.
The agency certifies that legal counsel has reviewed
the proposal and found it to be within the state agency's legal authority
to adopt.
Filed with the Office
of the Secretary of State on February 26, 2018
TRD-201800808 Tyler Vance
Interim
Executive Director
State Board of Dental Examiners
Earliest possible date of adoption: April 8, 2018
For further information, please call: (512) 475-0977
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