| (a) For purposes of this rule, the following definitions
apply:
(1) "Pediatric patient" means a patient younger than
13 years of age.
(2) "Board-approved education program" means an in-person
or online program provided by a recognized continuing education provider
pursuant to §104.2 of this title (relating to Providers) and
any subsequent amendments.
(b) On or after September 1, 2019, a permit holder
may not administer sedation/anesthesia under a level 2, level 3, or
level 4 permit to a pediatric patient unless the permit holder has
completed the requirements of paragraphs (1) or (2) of this subsection.
Permit holders must have:
(1) completed a university or hospital-based residency
at least 12 months in length. All permit holders completing a university
or hospital-based residency after September 1, 2019, must confirm
that during the residency, the permit holder completed satisfactory
management of sedation/anesthesia involving pediatric patients sedated/anesthetized
at the highest level of permit held. The cases must include: (i) at
least three (3) live cases in which the permit holder is the primary
sedation/anesthesia provider, or (ii) at least fifteen (15) cases
involving pediatric patients sedated/anesthetized where no more than
seven (7) cases are observed on live patients or high-fidelity sedation
simulators, and at least eight (8) cases are performed as part of
a hands-on high-fidelity sedation simulation center or program; 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 pediatric patients. The entire
board-approved education program, including all didactic and clinical
requirements, must be completed within a two-year period of beginning
the Board-approved program. Successful completion of the program must
include passing an evaluation to demonstrate satisfactory completion
of the course requirements. Didactic education must include:
(A) pre-anesthetic patient assessment/evaluation for
pediatric patients;
(B) physical evaluation and medical history of pediatric
patients, including obesity, limited neck mobility, micro/retrognathia,
macroglossia, Mallampati score, and limited oral opening;
(C) pediatric anatomical and physiological differences;
(D) pediatric respiratory assessment, including airway
anatomy, physiology, and management;
(E) informed consent by parent, guardian, or care-giver;
(F) sedation/anesthesia pharmacology;
(G) sedation/anesthesia management of pediatric patients;
(H) pediatric patient monitoring;
(I) peri-operative complications and emergencies;
(J) emergency management of pediatric patients, including
pediatric anesthesia equipment and resuscitation supplies;
(K) sedation/anesthesia technique;
(L) sedation/anesthesia record keeping;
(M) patient recovery and discharge;
(N) pediatric case selection and reference behavior
scale; and
(O) permit holders shall have completed satisfactory
management of sedation/anesthesia involving pediatric patients sedated/anesthetized
at the highest level of permit held. 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 pediatric patients. The cases must include: (i) at least three
(3) live cases in which the permit holder is the primary sedation/anesthesia
provider, or (ii) at least fifteen (15) cases involving pediatric
patients sedated/anesthetized where no more than seven (7) cases are
observed on live patients or high-fidelity sedation simulators, and
at least (8) cases are performed as part of a hands-on high-fidelity
sedation simulation center or program.
(c) A permit holder is authorized to administer sedation/anesthesia
under a level 2, level 3, or level 4 permit to a pediatric patient
if they have completed the requirements above and have requested and
received authorization from the Board to administer sedation/anesthesia
to pediatric patients. Board staff shall promulgate appropriate forms
for permit holders qualifying under subsection (b)(1) and (b)(2) of
this section. The permit holder must attest to their advanced training
satisfying the requirements of subsection (b)(1) or (b)(2) of this
section, and 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 pediatric patient.
(d) The education hours described in subsection (b)(2)
of this section can be applied towards the permit holder's continuing
education requirement for maintaining a sedation/anesthesia permit.
(e) If qualifying under subsection (b)(2) of this section,
the didactic and clinical training described in subsection (b)(2)
of this section may not be fulfilled by the same didactic and clinical
training used to fulfill the requirements for initial sedation/anesthesia
permit issuance.
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