Arkansas Administrative Code › Agency 007 - ARKANSAS DEPARTMENT OF HEALTH › Division 33 - Division of Health Related Boards and Commissions › Rule 007.33.20-034 - Article XIII- Analgesia, Conscious Sedation, Deep Serdation, and General Anesthesia Rules for a Dentist in an Ambulatory Facility

Current through Register Vol. 49, No. 6, June, 2024
A. DEFINITIONS
1. Analgesia - The diminution of pain or
			 production of increased tolerance to pain in the conscious patient.
2. Anesthesia - Partial or complete loss of
			 sensation with or without the loss of consciousness.
3. Anesthesia Period - The period of time
			 beginning with the placement of a needle, mask, or solution into or onto the
			 body until the patient has met the criteria which are appropriate for
			 dismissal.
4. Levels of Supervision
			 for Qualified Staff
a. Direct Supervision -
			 The dentist is in the dental office, authorizes the procedure, and remains in
			 the dental office while the procedures are being performed by the
			 auxiliary.
b. Personal Supervision
			 - The dentist is in the dental office, personally authorizes the procedure, and
			 before the dismissal of the patient, evaluates the patient.
c. Operative Supervision- The dentist is
			 personally operating on the patient and authorizes the auxiliary to aid the
			 treatment by concurrently performing a supportive procedure.
5. Nitrous Oxide/Oxygen
			 Inhalation Analgesia - The administration, by inhalation, of a combination of
			 nitrous oxide and oxygen producing an altered level of consciousness that
			 retains the patient's ability to independently and continuously maintain an
			 airway and respond appropriately to physical stimulation and/or verbal command.
			 Nitrous oxide/ oxygen inhalation analgesia, when used alone, is not considered
			 a form of sedation but is considered to be an analgesic only.
6. Qualified Staff- An individual trained to
			 monitor appropriate physiological parameters and to help in any supportive or
			 resuscitating measures.
a. For dentists using
			 Minimal or Moderate Sedation
Level
, qualified staff
			 must
be a
certified assistant
, have a current
				Nitrous Oxide Permit from the Board and be currently certified in health care
				provider CPR.
b. For
			 dentists using Deep or General Sedation, qualified staff must have a current
			 Nitrous Oxide Permit from the Board and be currently certified in Healthcare
			 Provider CPR AND have completed a Board approved course as outlined in Section
			 G of this rule and be registered with the Board as a Sedation Assistant.
7. Minimal Sedation - 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. The
			 patient should be oriented to person, place and time. Although cognitive
			 function and coordination may be modestly impaired, ventilatory and
			 cardiovascular functions are unaffected. In accordance with this particular
			 definition, the drug and/or techniques used should carry a margin of safety
			 wide enough never to render unintended loss of consciousness. Further, patients
			 whose only response is refiex withdrawal from repeated painful stimuli would
			 not be considered to be in a state of minimal sedation. When the intent is
			 minimal sedation for adults, the appropriate initial dosing of a single enteral
			 drug is no more than the maximum recommended dose of a drug that can be
			 prescribed for unmonitored home use. When the intent is Minimal Sedation, only
			 one drug can be given in addition to nitrous oxide.
Pediatric Considerations:
In addition lo (he
			 physiologic parameters for Minima! Sedation in children under J 2 years of age.
			 when (he intent is Minimal Sedation, only one drug can be given in addition
			 (oni(rous oxide. A drug CANNOT he from the scheduled category of drugs II. Ill
			 or IV with the exception of diazepam. If a child under 12 years of age is given
			 any drug for sedation from Schedule II, III or IV, with (he exception of
			 diazepam, (hat child is considered more than minimally sedated.
8. Moderate Sedation - 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. In accordance with this particular definition, the drugs and/or
			 techniques used should carry a margin of safety wide enough to render
			 unintended loss of consciousness unlikely. Repeated dosing of an agent before
			 the effects of previous dosing can be fully appreciated may result in a greater
			 alteration of the state of consciousness than is the intent of the dentist.
			 Further, a patient whose only response is reflex withdrawal from a painful
			 stimulus is not considered to be in a state of moderate sedation.
9. Deep Sedation- 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.
10. General Anesthesia - 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.
11. Titration- administration of incremental
			 doses of a drug until a desired effect is reached. Knowledge of each drug's
			 time of onset, peak response and duration of action is essential to avoid over
			 sedation. Although the concept of titration of a drug to effect is critical for
			 patient safety, when the intent is moderate sedation one must know whether the
			 previous dose has taken full effect before administering an additional drug
			 increment.
12. Routes of
			 Administration Defined
a. Enteral: any
			 technique of administration in which the agent is absorbed through the
			 gastrointestinal tract or oral mucosa (i.e. oral, rectal,
			 sublingual).
b. Parenteral: a
			 technique of administration in which the drug bypasses the gaslro intestinal
			 tract (i.e, intramuscular, intravenous, intranasal, sub mucosal. subcutaneous,
			 intraosseous).
c. Transdermal: a
			 technique of administration in which the drug is administered by patch or
			 iontophoresis through skin.
d.
			 Transmucosal: a technique of administration in which the drug is administered
			 across mucosa such as intranasal, sublingual or rectal.
e. Inhalation: a technique of administration
			 in which a gaseous or volatile agent is introduced into the lungs and whose
			 primary effect is due to absorption through the gas/blood interface.
13. Patient Physical
			 Status Classification (as defined by the American Society of
			 Anesthesiologists).
a. ASA I: A normal
			 healthy patient
b. ASA II: A
			 patient with mild systemic disease
c. ASA III: A patient with severe systemic
			 disease
d. ASA IV: A patient with
			 severe systemic disease that is a constant threat to life
e. ASA V: A moribund patient who is not
			 expected to survive without the operation
f. ASA VI: A declared brain-dead patient
			 whose organs are being removed for donor purposes
g. E: Emergency operation of any variety
			 (used to modify one of the above classifications, i.e. ASA III-E).
14. Maximum Recommended
			 Dose (MRD) - maximum FDA- recommended dose of a drug as printed in FDA-approved
			 labeling for unmonifored home use.
15. Incremental Dosing- administration of
			 multiple doses of a drug until a desired effect is reached, but not to exceed
			 the MRD.
16. Supplemental Dosing-
			 during minimal sedation, supplemental dosing is a single additional dose of the
			 initial drug that may be necessary for prolonged procedures. The supplemental
			 dose should not exceed one-half of the initial total dose and should not be
			 administered until the dentist has determined the clinical half-life of the
			 initial dosing has passed. The total aggregate dose must not exceed 1.5 x the
			 MRD on the day of treatment.
17.
			 Pediatric Sedation- Any level above nitrous oxide analgesia on patients under
			 the age of twelve (12) years.
18.
			 Permit reclassification- All Level 3 permits currently held by any dentists on
			 the date of adoption of this Rile will be reclassified to Moderate Sedation
			 permits. All Level 4-General Anesthesia permits currently held by any dentists
			 on the date of adoption of this rule will be reclassified to Deep
			 Sedation-General Anesthesia permits currently held by any dentist on the date
			 of adoption of this rule will be reclassified to Deep Sedation-General
			 Anesthesia pennits.