Mont. Admin. R. 24.138.3211 - DEFINITIONS RELATED TO ANESTHESIA
(1)
"Administration is as follows :
(a) "enteral
administration" means the agent is absorbed through the gastrointestinal tract
or oral mucosa (oral, rectal, or sublingual);
(b) "parenteral administration" means the
agent is absorbed intramuscularly, intravenously, intranasally, submucosally,
subcutaneously, or intraosseously;
(c) "transdermal administration" means the
agent is absorbed through a patch or by iontophoresis through the
skin;
(d) "transmucosal
administration" means the agent is absorbed across the mucosa (intranasal,
rectal, or sublingual); and
(e)
"inhalation administration" means a gaseous or volatile agent is introduced
into the lungs and absorbed through the gas/blood interface. Because sedation
and general anesthesia are a continuum, it is not always possible to predict
how an individual patient will respond. Practitioners intending to produce a
given level of sedation should be able to diagnose and manage the physiologic
consequences (rescue) for patients whose level of sedation becomes deeper than
initially intended.
(2)
"Deep sedation" means a drug-induced depression of consciousness during which
patients cannot be easily aroused, but respond purposefully following repeated
or painful stimulation. The ability to independently maintain ventilatory
function may be impaired. Patients may require assistance in maintaining a
patent airway, and spontaneous ventilation may be inadequate. Cardiovascular
function is usually maintained.
(3)
"General anesthesia" means a drug-induced loss of consciousness during which
patients are not arousable, even by painful stimulation. The ability to
independently maintain ventilatory function is often impaired. Patients often
require assistance in maintaining a patent airway, and positive pressure
ventilation may be required, because of depressed spontaneous ventilation or
drug-induced depression of neuromuscular function. Cardiovascular function may
be impaired.
(4) "Incremental
dosing" means administration of multiple doses of an agent until the desired
effect is obtained, not to exceed the maximum recommended dose (MRD).
(5) "Inhalation sedation" means the use of
nitrous oxide/oxygen in concentrations of up to 70/30 percent to provide mild
relaxation and analgesia. Nitrous oxide/oxygen may produce minimal sedation,
moderate sedation, deep sedation, or general anesthesia when used in
combination with a sedative agent or agents. Inhalation sedation may be used in
the pediatric or adult populations.
(6) "Maximum recommended dose" (MRD) means
maximum Food and Drug Administration (FDA)-recommended dose of a drug, as
printed in the FDA-approved labeling for unmonitored dose.
(7) "Minimal sedation" means a minimally
depressed level of consciousness, produced by a pharmacological method, that
retains the patient's ability to independently and continuously maintain an
airway and respond normally to tactile stimulation and verbal command. Although
cognitive function and coordination may be modestly impaired, ventilatory and
cardiovascular functions are unaffected. When the intent is minimal sedation
for adults, the appropriate dose of a single enteral drug is no more than the
MRD of a drug that can be prescribed for unmonitored home use.
(8) "Moderate sedation" means a drug-induced
depression of consciousness during which patients respond purposefully to
verbal commands, either alone or accompanied by light tactile stimulation. No
interventions are required to maintain a patent airway, and spontaneous
ventilation is adequate. Cardiovascular function is usually maintained. The
drugs and/or techniques used for moderate sedation should render the unintended
loss of consciousness unlikely. Repeated dosing of an agent before the effects
of previous dosing is obtained may result in a greater alteration of the state
of consciousness than intended. A patient whose only response is reflex
withdrawal from a painful stimulus is not in a state of moderate
sedation.
(9) "Supplemental dosing"
means a single additional dose of the initial dose of the initial drug
necessary for prolonged procedures under minimal sedation. The supplemental
dose should not exceed one-half of the initial total dose and should not be
administered until the dentist has determined that one clinical half-life of
the initial dose has passed. The total aggregate dose must not exceed one and a
half times the MRD on the day of administration.
(10) "Titration" is the administration of
incremental doses of a drug until a desired effect is obtained.
(11) "Trained healthcare professional" means
a person who serves as an anesthesia monitor in a dental office. Such person
shall maintain current certification in the American Heart Association's Basic
Life Support for Healthcare Providers or its equivalent, shall be trained in
monitoring patient vital signs, and shall be competent in the use of monitoring
and emergency equipment appropriate for the level of sedation utilized. (The
term "competent" as used in these rules means displaying special skill or
knowledge derived from training and experience).
Notes
37-1-131, 37-4-205, MCA; IMP, 37-4-101, 37-4-511, MCA;
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