Code of Massachusetts Regulations
234 CMR - BOARD OF REGISTRATION IN DENTISTRY
Title 234 CMR 6.00 - ADMINISTRATION OF ANESTHESIA AND SEDATION
Section 6.04 - Facility Permit D-A: Facility Requirements for the Administration of General Anesthesia and Deep Sedation

Universal Citation: 234 MA Code of Regs 234.6

Current through Register 1531, September 27, 2024

(1) Application. An applicant shall submit an accurate and complete application on form(s) provided by the Board and accompanied by the permit fee to be determined annually by the Executive Office of Administration and Finance. The application shall, at a minimum, include the following:

(a) Applicant name and Massachusetts dental license number;

(b) Name(s) of dental establishment(s), owner(s) of said establishment(s), and address(es) of the site(s) where anesthesia will be administered;

(c) Documentation of provision and maintenance of equipment, materials, and drugs required for the administration of general anesthesia and deep, moderate, minimal and nitrous oxide-oxygen sedation; and either
1. A written request for an on-site inspection conducted by the Board; or

2. A certificate of successful completion of an on-site inspection conducted by the Massachusetts Society of Oral and Maxillofacial Surgeons, if eligible by membership in that organization.

(2) Equipment Required for Facility Permit D-A. The following equipment shall be required to be provided and maintained on-site:

(a) Alternative light source for use during power failure;

(b) Ambu-bag or portable bag-mask ventilator;

(c) Automated or manual external defibrillator;

(d) Current certifications in Advanced Cardiac Life Support (ACLS);

(e) Disposable CPR masks, pediatric and adult;

(f) Disposable syringes (assorted sizes);

(g) Endotracheal tubes with inflatable cuffs and other equipment designed to maintain patient airway including:
1. Pediatric endotracheal tubes, assorted sizes;

2. Adult endotracheal tubes, assorted sizes;

3. Connectors from tubes to gas delivery machines;

4. Syringe for cuff inflation; and

5. Stylet.

(h) Endotracheal tube forceps;

(i) Equipment for emergency crico-thyroidotomy and/or tracheostomy with appropriate connectors to deliver 100% oxygen and establish an emergency airway;

(j) Equipment for the insertion and maintenance of an intravenous infusion

(k) Equipment suitable for proper positioning of the patient for administration of cardiopulmonary resuscitation, including a back board;

(l) Equipment for continuous monitoring during anesthesia;

(m) Gas delivery system capable of positive pressure ventilation, which must include:
1. Oxygen;

2. Safety-keyed hose attachments;

3. Capability to administer 100% oxygen in all rooms (operatory, recovery, examination, and reception);

4. Gas storage in compliance with safety codes;

5. Adequate waste gas scavenging system; and

6. Nasal hood or cannula.

(n) Laryngoscope (straight and/or curved blades, assorted sizes; extra batteries and bulbs);

(o) Latex free tourniquet;

(p) List of emergency telephone numbers clearly visible;

(q) Magill forceps or other suitable instruments;

(r) Means of monitoring blood pressure (pediatric and adult);

(s) Means of monitoring heart rate and rhythm, with battery pack back-up;

(t) Means of monitoring respirations;

(u) Means of monitoring temperature;

(v) Means of transporting patients;

(w) Method to accurately record elapsed time;

(x) Nasopharyngeal airways (pediatric and adult);

(y) Oropharyngeal airways (pediatric and adult);

(z) Oxygen (portable Cylinder E tank) pediatric and adult masks capable of giving positive pressure ventilation including bag-valve-mask system;

(aa) Scavenger system, if inhalation agents are used;

(bb) Sphygmomanometer and stethoscope (pediatric and adult);

(cc) Suction:
1. Suction catheter for endotracheal tube;

2. Tonsillar suction tip;

3. Suction equipment for use during power failure; and

4. Capability of suction in all operatories and recovery rooms.

(dd) Schedule and log for checking and recording dates when anesthesia accessories and supply of emergency drugs have been checked;

(ee) If nitrous oxide and oxygen delivery equipment capable of delivering less than 25% oxygen is used, an in-line oxygen analyzer must be used; and

(ff) Any other equipment as may be required by the Board.

(3) Drugs Required for Facility Permit D-A. The following drugs and/or categories of drugs shall be provided and maintained in accordance with the AHA/ACLS Guidelines ( 234 CMR 6.02) or as determined by the Board for emergency use. All drugs shall be current and not expired.

(a) Acetylsalicylic acid (rapidly absorbable form);

(b) Ammonia inhalants;

(c) Anticonvulsant;

(d) Antihistamine;

(e) Antihypolglycemic agent;

(f) Antihypertensive medications;

(g) Antiemetic;

(h) Atropine;

(i) Bronchodilator;

(j) Corticosteroid;

(k) Dantrolene Sodium (required if a halogenated anesthesia agent e.g. halothane, enflurane, isoflurane is used or depolorizing skeletal muscle relaxants e.g. succinylcholine are administered);

(l) Epinephrine pre-loaded syringes and ampules (pediatric and adult);

(m) Lidocaine;

(n) Intravenous antihypoglycemic agent (dextrose 50% or glucagon);

(o) Medication to treat supraventricular tachycardia (e.g. adenosine, verapamil, etc);

(p) Muscle relaxants;

(q) Narcotic antagonist and reversing agents;

(r) Oxygen;

(s) Sodium bicarbonate;

(t) Succinylcholine;

(u) Vasodilator;

(v) Vasopressor; and

(w) And any other drugs or categories of drugs as may be required by the Board.

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