Current through Register Vol. 48, No. 12, March 22, 2024
Deep sedation and general anesthesia must be administered by
an individual qualified under this Section. (See Appendix D for characteristics
of levels of anesthesia.)
a) A licensed
dentist seeking a permit to administer deep sedation or general anesthesia
shall make application to the Division, on forms provided by the Division, that
shall include:
1) Certification of meeting one
or more of the following:
A) Completion of a
minimum of 2 years of advanced training in anesthesiology beyond the
pre-doctoral level, in a training program approved by the American Dental
Association, Commission on Dental Education, as outlined in Guidelines for
Teaching Pain Control and Sedation to Dentists and Dental Students, published
by the American Dental Association, Commission on Dental Education (October
2012).
B) Be a diplomate of the
American Board of Oral and Maxillofacial Surgery.
C) Have an active, approved application with
the American Board of Oral and Maxillofacial Surgery to obtain diplomat
status.
D) Have a specialty license
in oral and maxillofacial surgery issued by the Division;
2) A signed affidavit certifying that:
A) the dentist will practice in a facility
properly equipped in accordance with subsection (d) for the administration of
deep sedation and general anesthesia;
B) the facility will be staffed with an
anesthesia team, supervised by the applicant, that will remain in the treatment
room during the procedure on the patient. For each patient, the anesthesia team
will consist of at least:
i) the dentist who
holds the permit B;
ii) one dental
hygienist or dental assistant who has completed the training prescribed in
Section 1220.240(f) or
1220.245(c)(2)
and is capable of assisting with procedures, problems and emergencies incident
to the administration of the sedation; and
iii) one additional hygienist or dental
assistant;
C) the
dentist permit holder will remain immediately available to the patient after
being treated under deep sedation or general anesthesia. A dental hygienist or
dental assistant trained to monitor a patient under deep sedation or general
anesthesia will remain with the sedated patient until the patient is no longer
sedated;
D) all members of the
anesthesia team are capable of assisting with procedures, problems and
emergencies incident to the administration of sedation and will maintain
current certification in BLS or its equivalent; and
E) for the dentist permit holder, the BLS
certification is in addition to the required 9 sedation technique CE hours (see
subsection (h)) required per renewal cycle;
3) Proof of current ACLS or PALS
certification; and
4) The required
fee set forth in Section
1220.415.
b) In accordance with the standards set forth
in this Section, the Division will issue a deep sedation or general anesthesia
permit (Permit B).
c) If the
accuracy, relevance or sufficiency of any submitted documentation is questioned
by the Division or the Board because of discrepancies or conflicts in
information needing further clarification, and/or missing information,
additional documentation may be required and/or an on-site evaluation of the
facilities, equipment and personnel may be conducted by the Division or a
member of the Board's Anesthesia Review Panel.
d) A properly equipped facility for the
administration of deep sedation or general anesthesia shall include, at a
minimum:
1) Sphygmomanometer and
stethoscope;
2) An oxygen delivery
system with full face masks and connectors appropriate to the patient
population being served that is capable of delivering oxygen to the patient
under positive pressure, with an emergency backup system;
3) Emergency drugs and equipment appropriate
to the medications administered;
4)
Suction equipment, including an emergency backup suction system;
5) An emergency backup lighting system that
will permit the completion of any operation underway;
6) Laryngoscope complete with selection of
blades and spare batteries and bulbs in sizes appropriate to the patient
population being served;
7)
Endotracheal tubes and connectors in sizes appropriate for the patient
population being served;
8)
Tonsillar or pharyngeal suction tips adaptable to all office outlets;
9) Nasal and oral airways in sizes
appropriate to the patient population being served;
10) Device for monitoring temperature (e.g.,
temperature strips, thermometer);
11) Electrocardioscope and defibrillator (an
automated external defibrillator is an acceptable defibrillator);
12) Pulse oximeter;
13) Equipment for the establishment of an
intravenous infusion;
14) An
operating table or an operating chair that permits appropriate access to the
patient and provides a firm platform for the management of cardiopulmonary
resuscitation; and
15) A recovery
area that has available oxygen, lighting, suction and electrical outlets. The
Permit B holder shall remain with the patient until the patient retains the
ability to independently and consciously maintain an airway and respond
appropriately to physical stimulation and oral commands. The recovery area may
be the operating theatre.
e) The following records shall be kept when
administering deep sedation and general anesthesia:
1) Medical history and patient evaluation
prior to the performance of any procedure;
2) Preoperative, intraoperative, and
pre-discharge monitoring of blood pressure, pulse, respiration and oxygen
saturation. A time based record shall be entered into the patient's
chart;
3) EKG monitoring during the
entire procedure;
4) Drugs and
dosages of agents used during the operative procedure, including nitrous oxide
and oxygen, and including identification of the person administering drugs and
times of their administration over the course of the procedure. Documentation
of the anesthetic encounter will be consistent with currently accepted
standards of anesthetic practice.
f) The dentist who holds the Permit B shall
report adverse occurrences to the Division and the Board as required by Section
1220.405.
g) A licensed dentist shall hold a Permit B
in order to perform dentistry while a licensed certified nurse anesthetist
administers deep sedation or general anesthesia. A nurse anesthetist for
purposes of this Section is a licensed certified nurse anesthetist who holds a
license as an advanced practice nurse under the Nurse Practice Act. The dentist
shall enter into a written collaborative agreement with the nurse anesthetist
in accordance with the following:
1) A
certified registered nurse anesthetist who provides anesthesia services in a
dental office shall enter into a written collaborative agreement with the
operating dentist performing the procedure. The agreement shall describe the
working relationship of the nurse anesthetist and the operating dentist and
shall authorize the categories of care, treatment, or procedures to be
performed by the nurse anesthetist. In a collaborating dentist office, the
nurse anesthetist may only provide those services that the operating dentist
with the appropriate permit is authorized to provide as found in 68 Ill. Adm.
Code 1220.510 and
1220.520.
2) For anesthesia services, the operating
dentist shall approve the anesthesia plan prepared by the nurse anesthetist and
shall remain physically present and be available on the premises during the
delivery of anesthesia services for diagnosis, consultation, and treatment of
emergency medical conditions. The nurse anesthetist may select, order, and
administer medications, including controlled substances, and apply appropriate
medical devices for delivery of anesthesia services under the anesthesia plan
agreed with by the operating dentist.
h) Proof of 9 hours of continuing education
per renewal cycle in sedation techniques, including medications and recognition
and management of complications and emergencies, is required for renewal of
Permit B.
i) A treating dentist
does not need to hold Permit B to perform dentistry when another dentist, who
holds Permit B, or a physician or dental anesthesiologist assists the treating
dentist by administering deep sedation or general anesthesia. Physician for
purposes of this Section means a physician who is licensed to practice medicine
in all of its branches under the Medical Practice Act of 1987 and is authorized
to provide anesthesia services in a licensed hospital or licensed ambulatory
surgical treatment center or is a Board-certified anesthesiologist.
1) The treating dentist shall be prepared to
provide affidavits attesting to the following if requested by the Division:
A) That the facility used is equipped as
specified in subsection (d);
B)
That the dentist shall staff the facility with a team, supervised by the Permit
B holder or physician, that includes a minimum of 3 individuals per patient.
The team shall be composed of either:
i) One
dental hygienist or dental assistant who has completed the training prescribed
in Section 1220.240(f) or
1220.245(c)(2)
capable of assisting with procedures, problems and emergencies incident to the
administration of the sedation; the treating dentist; and the dentist who holds
a Permit B providing the anesthesia services;
ii) One dental hygienist or dental assistant;
the treating dentist; and a physician providing the anesthesia services;
or
iii) One dental hygienist or
dental assistant; the treating dentist; and a dental anesthesiologist providing
the anesthesia services.
C) That the Permit B holder will remain with
the patient until the patient retains the ability to independently and
consciously maintain an airway and respond appropriately to physical
stimulation and oral commands. The recovery area may be the operating
theatre.
2) All members
of the anesthesia team, including the treating dentist (non-Permit B holder)
must maintain certification in BLS or its equivalent.
3) In addition, the dentist shall report
severe adverse occurrences to the Division as set forth in Section
1220.405 and accept the
responsibility for verifying certification and licensure of any licensed
provider present during the deep sedation or general anesthesia of a patient
receiving dental care.
j) A dentist holding a Permit B shall
maintain current ACLS or PALS certification. ACLS or PALS certification shall
be in addition to the required 9 hours of anesthesia CE per renewal
cycle.
k) A dentist holding a
Permit B shall maintain a logbook indicating the sedation cases performed. The
log shall include the patient name, date, route of sedation administration,
drug name and dosage, and the names of anesthesia team members assisting. This
information shall be supplied to the Division upon request.
l) A dentist holding a Permit B must also
hold an active Illinois Controlled Substances License and current federal Drug
Enforcement Administration registration.