N.J. Admin. Code § 13:30-8.3 - Use of general anesthesia

(a) The use or employment of general anesthesia by a dentist without first having met the minimum standards of training and procedure as stated herein shall constitute a deviation from the normal standards of practice required of a licensee.

(b) General anesthesia consists of the deliberate use of any drug, combination of drugs, element or other material with the specified intent to induce a loss of sensation and consciousness.

(c) No dentist shall employ or use general anesthesia on an outpatient basis for dental patients unless such dentist possesses a permit or authorization issued by the State Board of Dentistry for a specified practice location, which shall be renewed biennially. A dentist shall obtain a separate general anesthesia permit for each practice location at which general anesthesia is administered, except as set forth at (i) below.

(d) In order to receive a permit pursuant to (c) above, the dentist shall apply on an official application form and submit certified or verifiable proof of the following:

1. Completion of a minimum of three years of post-doctoral training in oral surgery, or a minimum one-year training course in anesthesiology; or

2. Being a diplomate in oral surgery or is Board-eligible in oral surgery; or

3. Being a fellow of the American Dental Society of Anesthesiology, or is a member of the American Association of Oral and Maxillofacial Surgeons and/or is a member of the New Jersey Society of Oral and Maxillofacial Surgeons.

(e) Every applicant for a general anesthesia permit must certify that he or she employs no fewer than two persons who must be present in the office, at least one of whom shall assist in monitoring the patient under general anesthesia. Such personnel shall be certified by the permit holder as being trained in and capable of monitoring vital signs, and of assisting in emergency procedures.

(f) Every applicant for a general anesthesia permit must certify that he or she possesses basic equipment and supplies to deal with emergency situations, as required by the Board, which shall be readily accessible and maintained in good operating condition. The permit holder's facility shall contain the following readily accessible and properly operating equipment:

1. Emergency drug kit, consisting of, at a minimum, the following:

i. Analgesics;

ii. Local anesthetics;

iii. Vasopressors;

iv. Vasodilators (coronary);

v. Anti-bradicardic agents;

vi. Bronchodilators;

vii. Muscle relaxant for treatment of laryngospasm;

viii. Antihistamine;

ix. Narcotic antagonist;

x. Anticonvulsant;

xi. Steroids;

xii. Tranquilizers;

xiii. Anti-hypertensive;

xiv. Benzodiazepines;

xv. Benzodiazepine antagonist;

xvi. Anti-arrhythmic (for example, lidocaine or amiodarone);

xvii. Aspirin;

xviii. Nitroglycerine (tablets, paste, or spray);

xix. Antiemetic; and

xx. Dantrolene for those practice locations where succinylcholine is used routinely, but not for emergency use, or where halogenated hydrocarbon general anesthetic inhalation agents are used;

2. Battery-powered clocks or watches;

3. Stethoscope;

4. Mouth props (assorted adult and pediatric sizes);

5. Suction equipment capable of aspirating gastric contents from the mouth and pharynx;

6. Emergency suction device;

7. Nasopharyngeal tubes;

8. Oropharyngeal tubes;

9. A blood pressure monitoring device;

10. An EKG monitor;

11. A pulse oximeter or its equivalent;

12. Respiration monitoring equipment (for example, visible reservoir bag);

13. Intravenous solutions ("ACLS compatible" IV administration sets and tubing);

14. Syringes, needles, IV catheters, and tape scissors;

15. Laryngoscopes, assorted size blades, and spare batteries;

16. Endotracheal tubes (adult and pediatric sizes);

17. Magil forceps;

18. Yankauer type suction tips and catheter suction; and

19. A capnometer.

(g) Any permit holder invited by a dentist to provide general anesthesia services shall be responsible for compliance with all terms and conditions of this section, including the minimum requirements for assisting staff, as set forth at (e) above, equipment, as set forth at (f) above, and facility standards as set forth at (j) below.

(h) The dental facility of any permit holder shall be inspected and approved by the State Board of Dentistry, or its designee, once every five years.

(i) In a dental facility where a permit holder administers general anesthesia pursuant to this section, the mobile equipment, drugs, and supplies of the permit holder shall be inspected and approved by the State Board of Dentistry or its designee once every three years. "Mobile equipment, drugs, and supplies," for purposes of this subsection, means any equipment, drugs, and/or supplies that are transported and used by a permit holder to administer anesthesia in one or more dental facilities.

(j) All offices in which general anesthesia is administered shall, at a minimum, have the equipment and supplies as set forth at (f) above and N.J.A.C. 13:30-8.6, which shall be readily accessible and maintained in good operating condition and shall meet the following standards:

1. An operating room with space large enough to provide adequate accommodation of the patient on a table or in an operating chair, and allow an operating team consisting of at least three individuals to move about the patient without restriction or limitation;

2. A recovery area that has available oxygen and monitoring equipment, adequate lighting, suction, and electrical outlets. The recovery area can be the operating theatre; and

3. A lighting system adequate to permit visual evaluation of the patient's skin and mucosal color.

(k) This permit shall be renewed biennially upon satisfactory proof being submitted to the Board that the holder has completed at least 20 hours during the previous two year period in continuing education courses devoted to general anesthesia and approved by the Board.

(l) Satisfactory credit hours to fulfill the continuing education requirement may be obtained in any one of the following areas:

1. Professional service review organizations;

2. Teaching;

3. Lectures;

4. Seminars; or

5. Other methods approved by the Board.

(m) Prior to the administration of an anesthetic agent, the permit holder shall conduct a physical evaluation of the patient, review the patient's up-to-date medical history, which shall include any changes and any medications, including natural and homeopathic medications, allergies, and sensitivities. The patient history shall be maintained in the files of each dentist for a period of not less than seven years succeeding the taking of the same. Specific contemporaneous records on use of general anesthesia shall be kept and shall include the agents utilized, dosage, and duration. The patient record, including medical history, shall be maintained in accordance with N.J.A.C. 13:30-8.7.

(n) Any dentist who utilizes the services of a general anesthesia permit holder or an M.D. or D.O. who is a member of the anesthesiology staff of an accredited hospital or who is authorized to perform anesthesia services by the Board of Medical Examiners pursuant to N.J.A.C. 13:35-4Ashall not be deemed to be practicing general anesthesia provided that the general anesthesia permit holder or M.D. or D.O. remains present through patient discharge and bears full responsibility during the entire procedure and until any patient regains consciousness. Any general anesthesia permit holder invited by a dentist to provide general anesthesia services shall bear full responsibility for compliance with all terms and conditions of this rule including, but not limited to, the minimum requirements for equipment and assisting staff.

(o) A licensee who administers general anesthesia shall:

1. Be able to recognize and manage complications and medical emergencies from general anesthetic drug administrations;

2. Understand the clinical pharmacology of the drugs used for general anesthesia and the interactions of these drugs;

3. Maintain patient airways and support ventilation;

4. Monitor patients during the administration of general anesthesia using clinical evaluations and mechanical means, including the use of an EKG monitor, pulse oximeter, and capnogram, and the interpretation of such readings;

5. Manage patients during the post-operative period and assess patients' suitability for discharge; and

6. Maintain accurate anesthetic contemporaneous records including drugs, dosages, vital signs, and patient responses.

(p) Every applicant for a permit to use general anesthesia must obtain emergency training by completing the American Heart Association course in Basic Life Support for Healthcare Professionals, or its equivalent, and a course in Advanced Cardiac Life Support, or its equivalent, and must maintain current certification in these courses. All persons who assist in monitoring a patient under general anesthesia must have emergency training by completing the American Heart Association course in Basic Life Support for Healthcare Professionals, or its equivalent, or a course in Advanced Cardiac Life Support, or its equivalent. The permit applicant must furnish proof of the training and certification to the Board.

(q) Any designee of the Board shall be authorized during ordinary business hours to enter and inspect any dental office for the purpose of enforcing the provisions of this rule.

(r) Any licensee who administers general anesthesia without first having obtained a permit from the Board or any licensee who fails to comply with the rules set forth herein, shall be deemed to have engaged in professional misconduct and/or gross malpractice or negligence and may be subjected to appropriate disciplinary action including an action for the suspension or revocation of the licensee's license to practice dentistry in the State of New Jersey.

Notes

N.J. Admin. Code § 13:30-8.3

New Rule, R.1976 d.367, eff. 11/19/1976.
See: 8 N.J.R. 198(b), 8 N.J.R. 561(b).
Amended by R.1977 d.206, eff. 6/9/1977.
See: 9 N.J.R. 128(c), 9 N.J.R. 346(a).
Amended by R.1978 d.120, eff. 4/6/1978.
See: 9 N.J.R. 483(a), 10 N.J.R. 203(b).
Amended by R.1980 d.423, eff. 9/30/1980.
See: 12 N.J.R. 430(a), 12 N.J.R. 672(b).
(c)3 added; (d) amended to include last sentence concerning penalty.
Amended by R.1985 d.196, effective 4/15/1985.
See: 17 N.J.R. 378(a), 17 N.J.R. 972(a).
Amended by R.1985 d.548, effective 11/4/1985.
See: 17 N.J.R. 1864(b), 17 N.J.R. 2669(a).
Amended by R.1990 d.173, effective 3/19/1990.
See: 21 N.J.R. 3062(a), 22 N.J.R. 975(a).
In (a), use of anesthesia without meeting training standards shall constitute deviation of practice. Stylistic and codification revisions to (c)-(h). Deleted old (f) and (h). Added new (l)-(n).
Amended by R.2000 d.357, effective 9/5/2000.
See: 31 N.J.R. 2130(a), 32 N.J.R. 3327(a).
Inserted a new (g); recodified former (g) as (h); inserted a new (i); and recodified former (h) through (n) as (j) through (p).
Amended by R.2006 d.107, effective 3/20/2006.
See: 37 N.J.R. 581(a), 38 N.J.R. 1459(b).
In (m), added "general anesthesia" throughout; added "or who is authorized to perform anesthesia services by the Board of Medical Examiners pursuant to N.J.A.C. 13:35-4A"; and substituted "M.D. or D.O." for "anesthesiologist".
Amended by R.2021 d.035, effective 4/19/2021.
See: 51 N.J.R. 1648(a), 53 N.J.R. 619(c).
Rewrote the section.
Amended by R.2022 d.003, effective 1/3/2022.
See: 51 N.J.R. 1648(a), 53 N.J.R. 614(a), 54 N.J.R. 83(a).
In (h), inserted a comma following "Dentistry" and substituted "five" for "six".