| (C) The dentist must determine and document that the
patient's level of consciousness, oxygenation, ventilation, and circulation
are satisfactory prior to discharge. The dentist shall not leave the
facility until the patient meets the criteria for discharge and is
discharged from the facility.
(D) Post-procedure verbal and written instructions
must be given to the patient, parent, escort, guardian, or care-giver.
Post-procedure, patients should be accompanied by an adult caregiver
for an appropriate period of recovery.
(7) Special Situations.
(A) Special Needs Patients. Because many dental patients
undergoing deep sedation or general anesthesia are mentally and/or
physically challenged, it is not always possible to have a comprehensive
physical examination or appropriate laboratory tests prior to administering
care. When these situations occur, the dentist responsible for administering
the deep sedation or general anesthesia shall document the reasons
preventing the pre-procedure management.
(B) Management of Children. For children twelve (12)
years of age and under, the dentist should observe the American Academy
of Pediatrics/American Academy of Pediatric Dentists Guidelines for
Monitoring and Management of Pediatric Patients During and After Sedation
for Diagnostic and Therapeutic Procedures.
(8) Emergency Management.
(A) The dentist is responsible for the sedation management,
adequacy of the facility and staff, diagnosis and treatment of emergencies
associated with the administration of deep sedation or general anesthesia,
and providing the equipment and protocols for patient rescue. This
includes immediate access to pharmacologic antagonists and equipment
for establishing a patent airway and providing positive pressure ventilation
with oxygen.
(B) Advanced airway equipment, emergency medications
and a defibrillator must be immediately available.
(C) Appropriate pharmacologic agents must be immediately
available if known triggering agents of malignant hyperthermia are
part of the anesthesia plan.
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