Current through Register Vol. 63, No. 9, September 1, 2024
General anesthesia, deep sedation, moderate sedation, minimal
sedation and nitrous oxide sedation.
(1) The Board shall issue a General
Anesthesia Permit to an applicant who:
(a) Is
a licensed dentist in Oregon;
(b)
In addition to a current BLS for Healthcare Providers certificate or its
equivalent, maintains a current Advanced Cardiac Life Support (ACLS)
certificate and/or a Pediatric Advanced Life Support (PALS) certificate,
whichever is appropriate for the patient being sedated, and
(c) Satisfies one of the following criteria:
(A) Completion of an advanced training
program in anesthesia and related subjects beyond the undergraduate dental
curriculum that satisfies the requirements described in the current ADA
Guidelines for Teaching Pain Control and Sedation to Dentists and Dental
Students consisting of a minimum of 2 years of a postgraduate anesthesia
residency at the time training was commenced.
(B) Completion of any ADA accredited
postdoctoral training program, including but not limited to Oral and
Maxillofacial Surgery, which affords comprehensive and appropriate training
necessary to administer and manage general anesthesia, commensurate with these
Guidelines.
(C) In lieu of these
requirements, the Board may accept equivalent training or experience in general
anesthesia.
(2)
The following facilities, equipment and drugs shall be on site and available
for immediate use during the procedure 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 three 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 face mask 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) A recovery area that has available
oxygen, adequate lighting, suction and electrical outlets. The recovery area
can be the operating room;
(h)
Sphygmomanometer, precordial/pretracheal stethoscope, capnograph, pulse
oximeter, electrocardiograph monitor (ECG), automated external defibrillator
(AED), oral and nasopharyngeal airways, laryngeal mask airways, intravenous
fluid administration equipment; and
(i) Emergency drugs including, but not
limited to: pharmacologic antagonists appropriate to the drugs used,
vasopressors, corticosteroids, bronchodilators, intravenous medications for
treatment of cardiac arrest, narcotic antagonist, antihistaminic,
antiarrhythmics, antihypertensives and anticonvulsants.
(3) No permit holder shall have more than one
person under general anesthesia, deep sedation, moderate sedation, minimal
sedation or nitrous oxide sedation at the same time.
(4) During the administration of deep
sedation or general anesthesia, and at all times while the patient is under
deep sedation or general anesthesia, an anesthesia monitor, and one other
person holding a current BLS for Healthcare Providers certificate or its
equivalent, shall be present in the operatory in addition to the dentist permit
holder performing the dental procedures.
(5) Before inducing deep sedation or general
anesthesia the dentist permit holder who induces deep sedation or general
anesthesia 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 general anesthesia or deep 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; and
(c) 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.
(6) A patient under deep sedation or general
anesthesia shall be visually monitored at all times, including recovery phase.
A dentist permit holder who induces deep sedation or general anesthesia or
anesthesia monitor trained in monitoring patients under deep sedation or
general anesthesia shall monitor and record the patient's condition on a
contemporaneous record.
(7) The
patient shall be monitored as follows:
(a)
Patients must have continuous monitoring of their heart rate, heart rhythm,
oxygen saturation levels and respiration using pulse oximetry,
electrocardiograph monitors (ECG) and End-tidal CO2
monitors. The patient's blood pressure, heart rate and oxygen saturation shall
be assessed every five minutes, and shall be contemporaneously documented in
the patient record. The record must also include documentation of preoperative
and postoperative vital signs, all medications administered with dosages, time
intervals and route of administration. The person administering the anesthesia
and the person monitoring the patient may not leave the patient while the
patient is under deep sedation or general anesthesia;
(b) Once sedated, a patient shall remain in
the operatory for the duration of treatment until criteria for transportation
to recovery have been met.
(c)
During the recovery phase, the patient must be monitored, including the use of
pulse oximetry, by an individual trained to monitor patients recovering from
general anesthesia.
(8) A
dentist permit holder shall not release a patient who has undergone deep
sedation or general anesthesia except to the care of a responsible third party.
When a reversal agent is administered, the dentist permit holder shall document
justification for its use and how the recovery plan was altered.
(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 nausea or vomiting and has minimal dizziness.
(10) A discharge entry shall be
made in the patient's record by the dentist permit holder indicating the
patient's condition upon discharge and the name of the responsible party to
whom the patient was discharged.
(11) Pursuant to OAR 818-042-0115 a Certified
Anesthesia Dental Assistant, when directed by a dentist permit holder, may
introduce additional anesthetic agents to an infusion line under the direct
visual supervision of a dentist permit holder.
(12) Permit renewal. In order to renew a
General Anesthesia Permit, the permit holder must provide documentation of a
current BLS for Healthcare Providers certificate or its equivalent; a current
Advanced Cardiac Life Support (ACLS) certificate and/or a current Pediatric
Advanced Life Support (PALS) certificate; and must complete 14 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 ACLS and/or PALS certificates may be counted
toward this requirement. Continuing education hours may be counted toward
fulfilling the continuing education requirement set forth in OAR
818-021-0060.
Publications: Publications referenced are available from the
agency.
Statutory/Other Authority: ORS 679
Statutes/Other Implemented: ORS
679.250(7)
& 679.250(10)
