Wyo. Code R. 034-0001-4 – Dental Practice

Dental Examiners, Board of

Chapter 4: Anesthetic Administration

Effective Date: 08/07/2002 to 12/05/2002

Rule Type: Expired Emergency Rules & Regulations

Reference Number: 034.0001.4.08072002

CHAPTER IV

ANESTHETIC ADMINISTRATION

Section 1. Definitions. For the purpose of these rules relative to the administration of general anesthesia, parenteral sedation, nitrous oxide inhalation analgesia, and other general methods of anxiety and pain control by licensed dentists the following definitions shall apply:

(a) General Anesthesia means a controlled state of unconsciousness, produced by a pharmacologic agent, accompanied by a partial or complete loss of protective reflexes, including inability to independently maintain an airway and respond appropriately to physical stimulation or verbal command.

(b) Parenteral Sedation means a depressed level of consciousness produced by the parenteral administration of pharmacologic substances, that retains the patient's ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command.

(c) Nitrous Oxide Inhalation Analgesia means the administration by inhalation of a combination of nitrous oxide and oxygen producing an altered level of consciousness that retains the patient's ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command.

(d) Analgesia means the diminution or elimination of pain.

(e) Anxiolysis means the diminution or elimination of anxiety – pharmacological reduction of anxiety through the administration of a minor tranquilizer, which allows for uninterrupted interactive ability in a totally awake patient with no compromise in the ability to maintain a patent airway continuously and without assistance.

(f) Local Anesthesia means the elimination of sensation, especially pain, in one part of the body by the topical application or regional injection of a drug.

(g) Conscious Sedation means a minimally depressed level of consciousness that retains the patient's ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command and that is produced by a pharmacological or non-pharmacological method or a combination thereof. In accordance with this particular definition, the drugs and/or techniques used carry a margin of safety wide enough to render unintended loss of consciousness unlikely. Further, patients whose only response is reflex withdrawal from repeated painful stimuli would not be considered to be in a state of conscious sedation.

(h) Combination Inhalation means enteral conscious sedation (combined conscious sedation) – conscious sedation using inhalation and enteral agents.

(i) Titration of oral medication for the purposes of sedation is unpredictable. Repeated dosing of orally-administered sedative agents may result in an alteration in the state of consciousness beyond the intent of the practitioner. Except in unusual circumstances, the Maximum Recommended Dose (MRD) of an oral medication should not be exceeded.

(ii) When the intent is anxiolysis only, and the appropriate dosage of agents is administered, then the definition of enteral and/or combination inhalation-enteral conscious sedation (combined conscious sedation) does not apply.

(i) Deep Sedation means an induced state of depressed consciousness accompanied by partial loss of protective reflexes, including the inability to continually maintain an airway independently and/or to respond purposefully to physical stimulation or verbal command, and is produced by a pharmacological or non-pharmacological method or a combination thereof.

(j) In accordance with the above definitions, any dentist wanting to effect conscious sedation, combination inhalation, deep sedation, or general anesthesia must comply with Chapter IV, Section 3 of the Wyoming Board of Dental Examiners Rules and Regulations.

Section 2. Prohibitions. The following are hereby prohibited:

(a) General Anesthesia: Effective July 1, 1991, dentists licensed in this state shall not administer general anesthesia in the practice of dentistry unless they have complied with the provisions of this rule.

(b) Parenteral Sedation: Effective July 1, 1991, dentists licensed in this state shall not administer parenteral sedation in the practice of dentistry unless they have complied with the provisions of this rule.

(c) Nitrous Oxide Inhalation Analgesia: Effective July 1, 1991, dentists licensed in this state shall not administer nitrous oxide inhalation analgesia in the practice of dentistry unless they have complied with the following provisions:

(i) A dentist may use nitrous oxide inhalation analgesia sedation on an out-patient basis for dental patients provided the dentist:

(A) Has completed a board approved course of training; or

(B) Has training equivalent to that required of a student in an accredited school of dentistry, and

(ii) A dentist utilizing nitrous oxide inhalation analgesia and auxiliary personnel who monitor its use shall be trained and capable of administering basic life support. This certification must be renewed in compliance with the standards set forth by the American Heart Association.

(iii) A licensed dentist who has been utilizing nitrous oxide inhalation analgesia in a competent manner for the twelve month period preceding the effective date of this rule, but has not had the benefit of formal training outlined in subsections (A) or (B), may continue such use provided the dentist fulfills the requirements of (C) above and is trained and capable of administering basic life support.

Section 3. Requirements for Administering Anesthesia.

(a) General Anesthesia: After July 1, 1991, general anesthesia may only be administered by a licensed dentist who has received a general anesthesia permit from the board. Permits will be issued by the board only after the following requirements have been met:

(i) Proof of Proficiency: A licensed dentist can show proof of proficiency in administering general anesthesia by successfully passing an appropriate examination which includes:

1. Discussion and review of three surgical cases including anesthetic technique

2. Review of records

3. Demonstration of managing emergencies

In addition, a dentist must provide:

(A) Proof that he has completed a minimum of one year of advanced training in anesthesiology and related academic subjects beyond the under graduate dental school level in a training program approved by the board; or

(B) Proof that he is a diplomate of the American Board of Oral and Maxillofacial Surgery; or

(D) Proof that he is a member of the American Association of Oral and Maxillofacial Surgeons; or

(E) Proof that he is a fellow of the American Dental Society of Anesthesiology; or

(F) Proof that he is a licensed dentist who has been utilizing general anesthesia in a competent manner for the five (5) year period preceding the effective date of this rule.

(ii) A dentist using general anesthesia shall provide and maintain proper equipment for the administration of general anesthesia staffed with supervised auxiliary personnel, capable of reasonable handling procedures, problems and emergencies incident thereto.

(iii) A dentist using general anesthesia shall be trained and capable of administering advanced cardiac life support. This certification shall be renewed in compliance with the standards set forth by the American Heart Association.

(iv) A dentist using general anesthesia shall employ auxiliary personnel who are trained and capable of administering basic life support. This certification shall be renewed in compliance with the standards set forth by the American Heart Association.

(v) A dentist who is performing a procedure for which general anesthesia was induced shall not administer the general anesthetic and monitor the patient without the presence and assistance of trained and capable auxiliary personnel.

(vi) A dentist qualified to administer general anesthesia under this rule may administer parenteral sedation and nitrous oxide inhalation analgesia.

(vii) General anesthetic equipment of permitted dentists shall be inspected on a regular basis as designated by the board to insure the equipment is of the appropriate type and is in working order.

(A) General Anesthesia equipment includes:

...Oxygen and supplemental gas-delivery system and backup system ...Suction and backup system ...Auxiliary lighting system ...Gas storage facilities ...Suitable operating suite ...Recovery areas ...Emergency anesthetic equipment and medications ...Monitoring equipment

(B) Inspection of offices where general anesthesia is administered shall be conducted every five (5) years.

(D) Any malfunctioning equipment shall be called to the attention of the applicant and a permit will not be issued until the experts determine all equipment is operating satisfactorily.

(E) The annual permit fee will be $45.00 which includes the parenteral sedation fee and is to be paid at the time of the license renewal. The renewal license shall indicate when the five (5) year inspection is due.

(F) A dentist shall apply to the secretary of the Board of Dental Examiners who will arrange with the qualified experts and the applicant dentist for an on-site inspection.

(G) Any permitted dentist who operates with malfunctioning equipment as determined by the board, shall cease administering general anesthesia until such equipment has been repaired. A copy of the work order showing satisfactory repair completed shall be sent to the secretary's office.

(viii) Any dentist using general anesthesia without a permit may have his license revoked or suspended.

(ix) The board shall establish examination fees as necessary to carry out this section.

(b) Parenteral Sedation: After July 1, 1991, parenteral sedation may only be administered by a licensed dentist who has received a parenteral sedation permit from the board. Permits will be issued by the board only after the following requirements have been met:

(i) Proof of Proficiency: A licensed dentist can show proof of proficiency in administering parenteral sedation by successfully passing an appropriate examination which includes:

1. Discussion and review of three surgical cases including anesthetic technique

2. Review of records

3. Demonstration of managing emergencies

In addition, a dentist must provide:

(A) Proof that he is a licensed dentist who has documented experience at the graduate level, acceptable to the board, specifying the type, the number of hours, the length of training and the number of patient contact hours, including documentation of the number of supervised parenteral sedation cases; or

(B) Proof that he is a licensed dentist who has successfully completed a formal training program, approved by the board, which included physical evaluation, IV sedation, airway management, monitoring, advanced cardiac life support and emergency management; or

(C) Proof that he is a licensed dentist who has been utilizing parenteral sedation on an out-patient basis in a competent manner for five (5) years preceding the effective date of this rule, but has not had the benefit of formal training as outlined in this rule. He may continue such use provided the licensed dentist fulfills the provisions set forth in (ii), (iii), (iv) and (v) below.

(ii) A dentist utilizing parenteral sedation shall maintain a properly equipped facility for the administration of parenteral sedation, staffed with supervised auxiliary personnel, capable of reasonable handling procedures, problems, and emergencies incident thereto.

(iii) A dentist using parenteral sedation shall be trained and capable of administering advanced cardiac life support. This certification shall be renewed in compliance with the standards set forth by the American Heart Association.

(iv) A dentist using parenteral sedation shall employ auxiliary personnel who are trained and capable of administering basic life support. This certification shall be renewed in compliance with the standards set forth by the American Heart Association.

(v) A dentist who is performing a procedure for which parenteral sedation is being employed shall not administer the pharmacologic agents and monitor the patient without the presence and assistance of trained and qualified auxiliary personnel.

(vi) Dentists qualified to administer parenteral sedation may administer nitrous oxide inhalation analgesic. (vii) If parenteral sedation results in a general anesthetic state, the rules for general anesthesia apply. (viii) Parenteral sedation equipment of permitted dentists shall be inspected on a regular basis as designated by the board to insure the equipment is of the appropriate type and is in working order.

(A) Parenteral Sedation equipment includes:

(B) Inspection of offices where parenteral sedation is administered shall be conducted every five (5) years.

(D) Any malfunctioning equipment shall be called to the attention of the applicant and a permit will not be issued until the experts determine all equipment is operating satisfactorily.

(E) The annual permit fee will be $45.00 which includes the general anesthesia fee and is to be paid at the time of the license renewal. The renewal license shall indicate when the five (5) year inspection is due.

(F) A dentist shall apply to the secretary of the Board of Dental Examiners who will arrange with the qualified experts and the applicant dentist for an on-site inspection.

(G) Any permitted dentist who operates with malfunctioning equipment as determined by the board, shall cease administering parenteral sedation until such equipment has been repaired. A copy of the work order showing satisfactory repair completed shall be sent to the secretary's office.

(ix) Any dentist using parenteral sedation without a permit may have his license revoked or suspended.

(x) The board shall establish examination fees as necessary to carry out this section.

Section 4. Reporting of Adverse Occurrences Related to General Anesthesia, Parenteral Sedation, and Nitrous Oxide Inhalation Analgesia.

(a) All licensed dentists in the practice of dentistry in this state should submit a report within a period of thirty (30) days to the board of any mortality or other incident which results in temporary or permanent physical or mental injury requiring hospitalization of said patient during, or as a result of, nitrous oxide inhalation analgesia, parenteral sedation, or general anesthesia related thereto. The report shall include, at the minimum, responses to the following:

(i) Description of dental procedure.

(ii) Description of preoperative physical condition of patient.

(iii) List of drugs and dosage administered.

(iv) Description, in detail, of techniques utilized in the administration of the above listed drugs.

(v) Description of adverse occurrence.

(A) Describe in detail symptoms of any complications, to include but not limited to onset, and type of symptoms in patient.

(B) Treatment instituted on the patient.

(vi) Describe patient's condition on termination of any procedures undertaken.