California Code of Regulations › Title 16 - Professional and Vocational Regulations › Division 10 - Dental Board of California › Chapter 2 - Dentists › Article 5 - General Anesthesia and Moderate Sedation › Section 1043.3 - Onsite Inspections

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
All offices in which general anesthesia, deep sedation, or
					 moderate sedation is conducted under the terms of this article shall, unless
					 otherwise indicated, meet the standards set forth below. In addition, an office
					 may in the discretion of the Board be required to undergo an onsite inspection.
					 For the applicant who administers in both an outpatient setting and at an
					 accredited facility, the onsite inspection must be conducted in an outpatient
					 setting. The evaluation of an office shall consist of three parts:
(a) Office Facilities and Equipment. All
				  equipment shall be maintained, tested, and inspected according to the
				  manufacturers' specifications. In an office where anesthesia services are to be
				  provided to pediatric patients, the required equipment, medication, and
				  resuscitative capabilities shall be appropriately sized for use on a pediatric
				  population. The following office facilities and equipment shall be available:
(1) An operating theatre 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.
(2) 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 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 operation underway at the time of general
				  power failure.
(4) Suction
				  equipment which permits aspiration of the oral and pharyngeal cavities. A
				  backup suction device which can operate at the time of general power failure
				  must also be available.
(5) An
				  oxygen delivery system with adequate full face masks and appropriate connectors
				  that is capable of allowing the administering of greater than 90% oxygen at a
				  10 liter/minute flow at least sixty minutes (650 liter "E" cylinder) to the
				  patient under positive pressure, together with an adequate backup system which
				  can operate at the time of general power failure.
(6) A recovery area that has available
				  oxygen, adequate lighting, suction, and electrical outlets. The recovery area
				  can be the operating theatre.
(7)
				  Ancillary equipment:
(A) Laryngoscope complete
				  with adequate selection of blades and spare batteries and bulb. (This equipment
				  is not required for moderate sedation.)
(B) Endotracheal tubes and appropriate
				  connectors. (This equipment is not required for moderate sedation.)
(C) Emergency airway equipment (oral airways,
				  laryngeal mask airways or combitubes, cricothyrotomy device).
(D) Tonsillar or pharyngeal type suction tip
				  adaptable to all office outlets.
(E) Endotracheal tube forceps. (This
				  equipment is not required for moderate sedation.)
(F) Sphygmomanometer and
				  stethoscope.
(G) Electrocardioscope
				  and defibrillator. (This equipment is not required for moderate
				  sedation.)
(H) Adequate equipment
				  for the establishment of an intravenous infusion.
(I) Precordial/pretracheal
				  stethoscope.
(J) Pulse
				  oximeter.
(K) Capnograph and
				  temperature device. Patients receiving moderate sedation, deep sedation, or
				  general anesthesia shall have ventilation continuously monitored during the
				  procedure by two of the following three methods:
(i) Auscultation of breath sounds using a
				  precordial stethoscope.
(ii)
				  Monitoring for the presence of exhaled carbon dioxide with
				  capnography.
(iii) Verbal
				  communication with a patient under moderate sedation. This method shall not be
				  used for a patient under deep sedation or general
				  anesthesia.