1. (1)       Equipment and supplies: Emergency resuscitation equipment, emergency life-saving medications, suction, and a reliable source of oxygen with a backup tank must be readily available. When medication for sedation and/or analgesia is administered intravenously (IV), monitoring equipment must include: blood pressure apparatus, stethoscope, pulse oximetry, continuous EKG, and temperature monitoring for procedures lasting longer than thirty (30) minutes. The patient’s vital signs, oxygen saturation, and level of consciousness must be documented prior to the procedure, during regular intervals throughout the procedure, and prior to discharge. During the procedure, the patient’s ventilatory function must be continually monitored by observation of qualitative clinical signs, including but not limited to, capnography, unless precluded or invalidated by the nature of the patient, procedure, or equipment. All patients must be continuously monitored by pulse oximetry with appropriate alarms. The physician office, in terms of general preparation, must have adequate equipment and supplies, provisions for proper record keeping, and the ability to recover patients after anesthesia.
2. (2)       Training required: The physician and at least one assistant must be currently trained in ACLS.
3. (3)       Assistance of other personnel: Anesthesia may be administered only by a licensed, qualified, and competent anesthesiologist, certified registered nurse anesthetist (CRNA) practicing under the direction of or in coordination with a licensed physician who is immediately available, anesthesiologist assistant (AA), who is practicing under the supervision of an anesthesiologist in accordance with Board rules (Chapter 540-X-7, et seq.), or registered nurse who has documented competence and training to administer Moderate Sedation / Analgesia (“Conscious Sedation”) and to assist in any support or resuscitation measures as required.
4. (4)       The individual administering Moderate Sedation / Analgesia (“Conscious Sedation”) and/or monitoring the patient must be someone other than the physician performing the surgical procedure, nor can this person assist in the actual performance of the procedure. Scrub or circulating nurse(s) and/or assistant(s) must be trained in their specific job skills as determined by the registered physician.
5. (5)       At least one physician currently trained in ACLS must be immediately and physically available until the last patient is past the first stage of recovery, and at least one practitioner currently trained in ACLS must be immediately and physically available until the last patient is discharged from the physician office.

Author: Alabama Board of Medical Examiners

Statutory Authority: Code of Ala. 1975, §34-24-53.

History: New Rule: Filed October 17, 2003; effective November 21, 2003. Repealed and New Rule: Published January 30, 2026; effective March 16, 2026.