1. (a) A dentist administering nitrous oxide or Level 1, 2, 3, or 4 sedation/anesthesia must create and maintain in the patient's dental records required by rule 108.8, a document titled "preoperative sedation/anesthesia checklist" that is completed by the dentist prior to commencing a procedure for which the dentist will administer nitrous oxide or Level 1, 2, 3, or 4 sedation/anesthesia. The checklist may be paper or electronic.
2. (b) A dentist delegating the administration of sedation/anesthesia to another provider in accordance with Section 258.001(4) of the Act, must maintain in the patient's dental records required by rule 108.8, a document titled "preoperative sedation/anesthesia checklist" that is completed by the sedation/anesthesia provider prior to commencing a procedure for which the dentist has delegated another provider to administer the sedation/anesthesia. The checklist may be paper or electronic.

3. (c) At a minimum, the preoperative checklist must include documentation of the following for each level of sedation/anesthesia:

   1. (1) Medical history, including documentation of the following:

      1. (A) review of patient medical history;
      2. (B) review of patient allergies;
      3. (C) review of patient surgical and/or anesthesia history;
      4. (D) review of family surgical and/or anesthesia history; and
      5. (E) review of patient medications and any modifications.
   2. (2) Confirmation that written and verbal preoperative and post-operative instructions were delivered to the patient, parent, legal guardian, or care-giver;
   3. (3) Medical consults, as needed;

   4. (4) Physical examination, including documentation of the following:

      1. (A) American Society of Anesthesiologists Physical Status Classification (ASA) classification;
      2. (B) NPO status; and
      3. (C) Preoperative vitals, including height, weight, blood pressure, pulse rate, and respiration rate;

   5. (5) Anesthesia-specific physical examination including documentation of the following:

      1. (A) Airway assessment, including Mallampati score and/or Brodsky score; and
      2. (B) Auscultation;
   6. (6) Confirmation of pre-procedure equipment readiness check;
   7. (7) Confirmation of pre-procedure treatment review (correct patient and procedure);
   8. (8) Special preoperative considerations as indicated for sedation/anesthesia administered to pediatric or high risk patients; and
   9. (9) Documentation of reason for omission of any item required by subsection (c) of this section.
4. (d) The information required above may be gathered at any time, but the dentist administering the sedation/anesthesia must verify that the information is current and correct prior to the administration of sedation/anesthesia.

Source Note:The provisions of this §110.13 adopted to be effective May 10, 2018, 43 TexReg 2777.