[(i)A positive-pressure oxygen delivery system suitable
for the patient being treated must be immediately available.]
[(ii)When inhalation equipment is used, it must have
a fail-safe system that is appropriately checked and calibrated. The
equipment must also have either:]
[(I)a functioning device that prohibits the delivery
of less than 30% oxygen; or]
[(II)an appropriately calibrated and functioning in-line
oxygen analyzer with audible alarm.]
[(iii)An appropriate scavenging system must be available
if gases other than oxygen are used.]
[(iv)The equipment necessary to establish intravenous
access must be available.]
[(v)Equipment and drugs necessary to provide advanced
airway management and advanced cardiac life support must be immediately
available.]
[(vi)If volatile anesthetic agents are utilized, an
inspired agent analysis monitor and capnograph should be considered.]
[(vii)Emergency medications and a defibrillator must
be immediately available.]
[(4)Monitoring. A qualified dentist administering
deep sedation or general anesthesia must remain in the operatory room
to monitor the patient continuously until the patient meets the criteria
for discharge to the recovery area. The dentist must not leave the
facility until the patient meets the criteria for discharge and is
discharged from the facility. Monitoring must include:]
[(A)Oxygenation.]
[(i)Color of mucosa, skin, or blood must be continually
evaluated.]
[(ii)Oxygenation saturation must be evaluated continuously
by pulse oximetry.]
[(B)Ventilation.]
[(i)Intubated patient: End-tidal CO2 must be continuously
monitored and evaluated.]
[(ii)Non-intubated patient: Breath sounds via auscultation
and/or end-tidal CO2 must be continually monitored and evaluated.]
[(iii)Respiration rate must be continually monitored
and evaluated.]
[(C)Circulation.]
[(i)Heart rate and rhythm via EKG and pulse rate via
pulse oximetry must be evaluated throughout the procedure.]
[(ii)Blood pressure must be continually monitored.]
[(D)Temperature.]
[(i)A device capable of measuring body temperature
must be readily available during the administration of deep sedation
or general anesthesia.]
[(ii)The equipment to continuously monitor body temperature
should be available and must be performed whenever triggering agents
associated with malignant hyperthermia are administered.]
[(5)Documentation.]
[(A)Documentation must be made in accordance with §108.7
and §108.8 of this title and must include the names, times and
dosages of all drugs administered and the names of individuals present
during administration of the drugs.]
[(B)A written time-oriented anesthetic record must
be maintained.]
[(C)Pulse oximetry and end-tidal CO2 measurements
(if taken with an intubated patient), heart rate, respiratory rate,
and blood pressure must be continually recorded at five (5) minute
intervals.]
[(6)Recovery and Discharge.]
[(A)Oxygen and suction equipment must be immediately
available if a separate recovery area is utilized.]
[(B)The dentist or 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 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.]
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 December 5, 2016
TRD-201606155 Kelly Parker
Executive Director
State Board of Dental Examiners
Earliest possible date of adoption: January 15, 2017
For further information, please call: (512) 475-0977
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