WAC 246-817-770   General anesthesia (including deep sedation).  Deep sedation and general anesthesia must be administered by an individual qualified to do so under this chapter.

     (1) Training requirements for monitoring personnel: In addition to those individuals necessary to assist the practitioner in performing the procedure, a trained individual must be present to monitor the patient's cardiac and respiratory functions. The individual monitoring patients receiving deep sedation or general anesthesia must have received a minimum of fourteen hours of documented training in a course specifically designed to include instruction and practical experience in use of all equipment required in this section. This must include, but not be limited to, the following equipment:

     (a) Sphygmomanometer;

     (b) Pulse oximeter;

     (c) Electrocardiogram;

     (d) Bag-valve-mask resuscitation equipment;

     (e) Oral and nasopharyngeal airways;

     (f) Defibrillator;

     (g) Intravenous fluid administration set.

     A course, or its equivalent, may be presented by an individual qualified under this section or sponsored by an accredited school, medical or dental association or society, or dental specialty association.

     (2) Procedures for administration: Patients receiving deep sedation or general anesthesia must have continual monitoring of their heart rate, blood pressure, and respiration. In so doing, the licensee must utilize electrocardiographic monitoring and pulse oximetry. The patient's blood pressure, heart rate, and respiration shall be recorded at least every five minutes. During deep sedation or general anesthesia, the person administering the anesthesia and the person monitoring the patient, may not leave the immediate area.

     During the recovery phase, the patient must be monitored continually by an individual trained to monitor patients recovering from general anesthesia or deep sedation. A discharge entry shall be made in the patient's record indicating the patient's condition upon discharge and the responsible party to whom the patient was discharged.

     (3) Equipment and emergency medications: All offices in which general anesthesia (including deep sedation) is administered must comply with the following recordkeeping and equipment standards:

     (a) Dental records must contain appropriate medical history and patient evaluation. Anesthesia records shall be recorded during the procedure in a timely manner and must include: Blood pressure, heart rate, respiration, blood oxygen saturation, drugs administered including amounts and time administered, length of procedure, any complications of anesthesia.

     (b) Office facilities and equipment shall include:

     (i) An operating theater large enough to adequately accommodate the patient on a table or in an operating chair and permit an operating team consisting of at least three individuals to freely move about the patient.

     (ii) An operating table or chair which permits the patient to be positioned so the operating team can maintain the airway, quickly alter patient position in an emergency, and provide a firm platform for the administration of basic life support.

     (iii) A lighting system which is adequate to permit evaluation of the patient's skin and mucosal color and a backup lighting system of sufficient intensity to permit conclusion of any operation underway at the time of general power failure.

     (iv) Suction equipment capable of aspirating gastric contents from the mouth and pharyngeal cavities. A backup suction device must be available.

     (v) An oxygen delivery system with adequate full face masks and appropriate connectors that is capable of delivering high flow oxygen to the patient under positive pressure, together with an adequate portable backup system.

     (vi) A recovery area that has available oxygen, adequate lighting, suction, and electrical outlets. The recovery area can be the operating theater.

     (vii) Ancillary equipment which must include the following:

     (A) Laryngoscope complete with adequate selection of blades, spare batteries, and bulb.

     (B) Endotracheal tubes and appropriate connectors.

     (C) Oral airways.

     (D) Tonsillar or pharyngeal suction tip adaptable to all office outlets.

     (E) Endotracheal tube forceps.

     (F) Sphygmomanometer and stethoscope.

     (G) Adequate equipment to establish an intravenous infusion.

     (H) Pulse oximeter.

     (I) Electrocardiographic monitor.

     (J) Synchronized defibrillator available on premises.

     (c) Drugs. Emergency drugs of the following types shall be maintained:

     (i) Vasopressor.

     (ii) Corticosteroid.

     (iii) Bronchodilator.

     (iv) Muscle relaxant.

     (v) Intravenous medications for treatment of cardiac arrest.

     (vi) Narcotic antagonist. Sedative antagonist, if available.

     (vii) Antihistaminic.

     (viii) Anticholinergic.

     (ix) Antiarrhythmic.

     (x) Coronary artery vasodilator.

     (xi) Antihypertensive.

     (xii) Anticonvulsant.

     (4) Continuing education: A dentist granted a permit to administer general anesthesia (including deep sedation) under this chapter, must participate in eighteen hours of continuing education every three years. A dentist granted a permit must maintain records that can be audited and must submit course titles, instructors, dates attended, sponsors, and number of hours for each course every three years. The education must be provided by organizations approved by the DQAC and must be in one or more of the following areas: General anesthesia, conscious sedation, physical evaluation, medical emergencies, monitoring and use of monitoring equipment, pharmacology of drugs and agents used in sedation and anesthesia, or basic life support (BLS), or advanced cardiac life support (ACLS).

     (5) A permit of authorization is required.



[Statutory Authority: RCW 18.32.035. 95-21-041, § 246-817-770, filed 10/10/95, effective 11/10/95.]