OAR 818-026-0050: Minimal Sedation Permit

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 or nitrous oxide 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), 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.