Current through Register Vol. 63, No. 9, September 1, 2024
Minimal sedation and nitrous oxide sedation.
(1) The Board shall issue a Minimal Sedation
Permit to an applicant who:
(a) Is a licensed
dentist in Oregon;
(b) Maintains a
current BLS for Healthcare Providers certificate or its equivalent;
and
(c) Completion of a
comprehensive training program consisting of at least 16 hours of training and
satisfies the requirements of the current ADA Guidelines for Teaching Pain
Control and Sedation to Dentists and Dental Students at the time training was
commenced or postgraduate instruction was completed, or the equivalent of that
required in graduate training programs, in sedation, recognition and management
of complications and emergency care; or
(d) In lieu of these requirements, the Board
may accept equivalent training or experience in minimal sedation
anesthesia.
(2) The
following facilities, equipment and drugs shall be on site and available for
immediate use during the procedures and during recovery:
(a) An operating room large enough to
adequately accommodate the patient on an operating table or in an operating
chair and to allow an operating team of at least two individuals to freely move
about the patient;
(b) An operating
table or chair which permits the patient to be positioned so the operating team
can maintain the patient's airway, quickly alter the patient's position in an
emergency, and provide a firm platform for the administration of basic life
support;
(c) A lighting system
which permits evaluation of the patient's skin and mucosal color and a backup
lighting system of sufficient intensity to permit completion of any operation
underway in the event of a general power failure;
(d) Suction equipment which permits
aspiration of the oral and pharyngeal cavities and a backup suction device
which will function in the event of a general power failure;
(e) An oxygen delivery system with adequate
full facemask and appropriate connectors that is capable of delivering high
flow oxygen to the patient under positive pressure, together with an adequate
backup system;
(f) A nitrous oxide
delivery system with a fail-safe mechanism that will insure appropriate
continuous oxygen delivery and a scavenger system;
(g) Sphygmomanometer, stethoscope, pulse
oximeter, and/or automatic blood pressure cuff; and
(h) Emergency drugs including, but not
limited to: pharmacologic antagonists appropriate to the drugs used,
vasopressors, corticosteroids, bronchodilators, antihistamines,
antihypertensives and anticonvulsants.
(3) Before inducing minimal sedation, a
dentist permit holder who induces minimal sedation shall:
(a) Evaluate the patient and document, using
the American Society of Anesthesiologists (ASA) Patient Physical Status
Classifications, that the patient is an appropriate candidate for minimal
sedation;
(b) Give written
preoperative and postoperative instructions to the patient or, when appropriate
due to age or psychological status of the patient, the patient's
guardian;
(c) Certify that the
patient is an appropriate candidate for minimal sedation; and
(d) Obtain written informed consent from the
patient or patient's guardian for the anesthesia. The obtaining of the informed
consent shall be documented in the patient's record.
(4) No permit holder shall have more than one
person under minimal sedation at the same time.
(5) While the patient is being treated under
minimal sedation, an anesthesia monitor shall be present in the room in
addition to the treatment provider. The anesthesia monitor may be the dental
assistant. After training, a dental assistant, when directed by a dentist
permit holder, may administer oral sedative agents or anxiolysis agents
calculated and dispensed by a dentist permit holder under the direct
supervision of a dentist permit holder.
(6) A patient under minimal sedation shall be
visually monitored at all times, including recovery phase. The record must
include documentation of all medications administered with dosages, time
intervals and route of administration. The dentist permit holder or anesthesia
monitor shall monitor and record the patient's condition.
(7) Persons serving as anesthesia monitors
for minimal sedation in a dental office shall maintain current certification in
BLS for Healthcare Providers Basic Life Support (BLS)/Cardio Pulmonary
Resuscitation (CPR) training, or its equivalent, shall be trained and competent
in monitoring patient vital signs, in the use of monitoring and emergency
equipment appropriate for the level of sedation utilized. ("competent" means
displaying special skill or knowledge derived from training and
experience.)
(8) The patient shall
be monitored as follows:
(a) Color of mucosa,
skin or blood must be evaluated continually. Patients must have continuous
monitoring using pulse oximetry. The patient's response to verbal stimuli,
blood pressure, heart rate, pulse oximetry and respiration shall be monitored
and documented every fifteen minutes, if they can reasonably be
obtained.
(b) A discharge entry
shall be made by the dentist permit holder in the patient's record indicating
the patient's condition upon discharge and the name of the responsible party to
whom the patient was discharged.
(9) The dentist permit holder shall assess
the patient's responsiveness using preoperative values as normal guidelines and
discharge the patient only when the following criteria are met:
(a) Vital signs including blood pressure,
pulse rate and respiratory rate are stable;
(b) The patient is alert and oriented to
person, place and time as appropriate to age and preoperative psychological
status;
(c) The patient can talk
and respond coherently to verbal questioning;
(d) The patient can sit up unaided;
(e) The patient can ambulate with minimal
assistance; and
(f) The patient
does not have uncontrollable nausea or vomiting and has minimal
dizziness.
(g) A dentist permit
holder shall not release a patient who has undergone minimal sedation except to
the care of a responsible third party.
(10) The permit holder shall make a discharge
entry in the patient's record indicating the patient's condition upon
discharge.
(11) Permit renewal. In
order to renew a Minimal Sedation Permit, the permit holder must provide
documentation of a current BLS for Healthcare Providers certificate or its
equivalent. In addition, Minimal Sedation Permit holders must also complete
four (4) hours of continuing education in one or more of the following areas
every two years: sedation, physical evaluation, medical emergencies, monitoring
and the use of monitoring equipment, or pharmacology of drugs and agents used
in sedation. Training taken to maintain current BLS for Healthcare Providers
certificate, or its equivalent, may not be counted toward this requirement.
Continuing education hours may be counted toward fulfilling the continuing
education requirement set forth in OAR 818-021-0060.
Statutory/Other Authority: ORS 679
Statutes/Other Implemented: ORS
679.250(7)
& 679.250(10)
