All equipment shall be maintained, tested, and inspected
according to the manufacturers' specifications. A facility in which oral
conscious sedation is administered to patients pursuant to this article shall
also meet the standards set forth below.
Facility and Equipment.
(1) An operatory large enough to adequately
accommodate the patient and permit a team consisting of at least three
individuals to freely move about the patient.
(2) A table or dental chair which permits the
patient to be positioned so the attending team can maintain the airway, quickly
alter patient position in an emergency, and provide a firm platform for the
management of cardiopulmonary resuscitation.
(3) A lighting system which is adequate to
permit evaluation of the patient's skin and mucosal color and a backup lighting
system which is battery powered and of sufficient intensity to permit
completion of any treatment which may be underway at the time of a general
(4) An appropriate
functional suctioning device that permits aspiration of the oral and pharyngeal
cavities. A backup suction device that can function at the time of general
power failure must also be available.
(5) A positive-pressure oxygen delivery
system capable of administering greater than 90% oxygen at a 10 liter/minute
flow for at least sixty minutes (650 liter "E" cylinder), even in the event of
a general power failure. All equipment must be age-appropriate and capable of
accommodating the patients being seen at the permit-holder's office.
(6) Inhalation sedation equipment, if used in
conjunction with oral sedation, must have the capacity for delivering 100%, and
never less than 25%, oxygen concentration at a flow rate appropriate for an age
appropriate patient's size, and have a fail-safe system. The equipment must be
maintained and checked for accuracy at least annually.
Ancillary equipment, which must include
(1) Age-appropriate oral
airways capable of accommodating patients of all sizes.
(2) An age-appropriate sphygmomanometer with
cuffs of appropriate size for patients of all sizes.
(3) A precordial/pretracheal
(4) A pulse
following records shall be maintained:
adequate medical history and physical evaluation, updated prior to each
administration of oral conscious sedation. Such records shall include, but are
not limited to, an assessment including at least visual examination of the
airway, the age, sex, weight, physical status (American Society of
Anesthesiologists Classification), and rationale for sedation of the patient as
well as written informed consent of the patient or, as appropriate, patient's
conservator, or the informed consent of a person authorized to give such
consent for the patient.
conscious sedation records shall include baseline vital signs. If obtaining
baseline vital signs is prevented by the patient's physical resistance or
emotional condition, the reason or reasons must be documented. The records
shall also include intermittent quantitative monitoring and recording of oxygen
saturation, heart and respiratory rates, blood pressure as appropriate for
specific techniques, the name, dose and time of administration of all drugs
administered including local and inhalation anesthetics, the length of the
procedure, any complications of oral sedation, and a statement of the patient's
condition at the time of discharge.
An emergency cart or kit shall be
available and readily accessible and shall include the necessary and
appropriate drugs and age- and size-appropriate equipment to resuscitate a
nonbreathing and unconscious patient and provide continuous support while the
patient is transported to a medical facility. There must be documentation
showing that all emergency equipment and drugs are checked and maintained on a
prudent and regularly scheduled basis. Emergency drugs of the following types
shall be available:
(3) Appropriate drug antagonists
(8) Dextrose or other