| (ii) Ventilation must be continually evaluated. This
can be accomplished by auscultation of breath sounds, monitoring end-tidal
CO2 or by verbal communication with the patient.
(D) Circulation.
(i) Blood pressure and heart rate must be continually
evaluated.
(ii) Continuous EKG monitoring of patients sedated
under moderate parenteral sedation is required.
(5) Documentation.
(A) Documentation must be made in accordance with §108.7
and §108.8 of this title.
(B) A written time-oriented anesthetic record must
be maintained and must include the names and dosages of all drugs
administered and the names of individuals present during administration
of the drugs.
(C) Pulse-oximetry, heart rate, respiratory rate, and
blood pressure must be continually monitored and documented at appropriate
intervals of no more than ten (10) minutes.
(6) Recovery and Discharge.
(A) Oxygen and suction equipment must be immediately
available if a separate recovery area is utilized.
(B) While the patient is in the recovery area, the
dentist or qualified clinical staff must continually monitor the patient's
blood pressure, heart rate, oxygenation, and level of consciousness.
(C) The dentist must determine and document that the
patient's level of consciousness, oxygenation, ventilation, and circulation
are satisfactory for 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.
(E) If a reversal agent is administered before discharge
criteria have been met, the patient must be monitored until recovery
is assured.
(7) 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 moderate sedation, 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 and resuscitation medications
must be available.
(C) A defibrillator should be available when ASA I
and II patients are sedated under moderate sedation. A defibrillator
must be available when ASA III and IV patients are sedated under moderate
sedation.
(D) Because sedation is a continuum, it is not always
possible to predict how an individual patient will respond. If a patient
enters a deeper level of sedation than the dentist is qualified to
provide, the dentist must stop the dental procedure until the patient
returns to the intended level of sedation. The dentist administering
moderate sedation must be able to recover patients who enter a deeper
state of sedation than intended.
(8) 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.
(d) A dentist who holds a moderate sedation permit
shall not intentionally administer deep sedation or general anesthesia.
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