Pennsylvania Code › Title 49 - PROFESSIONAL AND VOCATIONAL STANDARDS › Part I - DEPARTMENT OF STATE › Subpart A - PROFESSIONAL AND OCCUPATIONAL AFFAIRS › Chapter 33 - STATE BOARD OF DENTISTRY › Subchapter E - ADMINISTRATION OF GENERAL ANESTHESIA, DEEP SEDATION, CONSCIOUS SEDATION AND NITROUS OXIDE/OXYGEN ANALGESIA › Section 33.340 - Duties of dentists who are unrestricted permitholders

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A dentist who possesses an unrestricted
					 permit issued under this subchapter shall ensure that:
(1) Prior to the administration of general
					 anesthesia, deep sedation, conscious sedation or nitrous oxide/oxygen
					 analgesia, the permitholder takes or updates a patient medical history and
					 gives the patient a physical evaluation sufficient to determine the patient's
					 suitability to receive general anesthesia, deep sedation, conscious sedation or
					 nitrous oxide/oxygen analgesia.
(2)
					 The dental office in which the permitholder administers general anesthesia,
					 deep sedation, conscious sedation or nitrous oxide/oxygen analgesia on an
					 outpatient basis contains the following:
(i)
					 An operating room.
(ii) An
					 operating table or chair.
(iii) A
					 lighting system.
(iv) Suction
					 equipment commensurate with the patient's age, size and condition.
(v) Oxygen and supplemental gas delivery
					 systems, including primary and back-up sources and a fail-safe control
					 mechanism.
(vi) A sterilization
					 area.
(vii) A recovery
					 area.
(viii) A gas storage area and
					 scavenger system.
(ix) Emergency
					 airway equipment and medications, including intravenous emergency
					 equipment.
(x) Communications
					 equipment.
(xi) Patient transport
					 equipment.
(xii) Monitoring
					 equipment, procedures and documentation to conform to the age, size and
					 condition of the patient and the AAOMS Manual and AAOMS Guidelines for adult
					 and pediatric patients (OMS); the ADA Guidelines for adult patients (general
					 dentists); and the AAPD Guidelines for pediatric patients (general
					 dentists).
(xiii) Capnograph for
					 intubated patients and pulse oximeter.
(xiv) ECG.
(xv) Blood pressure monitoring
					 device.
(xvi)
					 Defibrillator.
(xvii) Results of
					 patient medical history and patient physical evaluation, and identification of
					 anesthesia procedures to be utilized, prior to the administration of general
					 anesthesia, deep sedation, conscious sedation or nitrous oxide/oxygen
					 analgesia.
(xviii) Signed, written,
					 informed patient consent, prior to the administration of general anesthesia,
					 deep sedation, conscious sedation or nitrous oxide/oxygen analgesia, which
					 includes a description of the procedure, its risks and possible alternative
					 treatments. Consent for a minor patient shall be obtained from the minor's
					 parent or guardian.
(xix)
					 Stethoscope.
(3)
					 Auxiliary personnel who assist the permitholder in the administration of
					 general anesthesia, deep sedation or conscious sedation:
(i) Are trained to perform the duties that
					 the permitholder delegates to them, if the duties do not require the
					 professional judgment and skill of the permitholder and do not involve the
					 actual administration of general anesthesia, deep sedation or conscious
					 sedation.
(ii) Perform their duties
					 under the direct on-premises supervision of the permitholder, who shall assume
					 full responsibility for the performance of the duties.
(iii) Do not render assistance in areas that
					 are beyond the scope of the permitholder's authority.
(iv) Are currently certified in
					 BLS.
(4) CRNAs who are
					 delegated the duties of administering general anesthesia, deep sedation or
					 conscious sedation:
(i) Perform their duties
					 under the direct on-premises supervision of the permitholder, who shall assume
					 full responsibility for the performance of the duties.
(ii) Do not perform duties that are beyond
					 the scope of the permitholder's authority.
(iii) Are currently certified in
					 ACLS.
(5) The dentist
					 possesses a current certification in ACLS for adult patients and PALS for
					 pediatric patients.
(6) The Board
					 receives a complete report of a death or incident requiring medical care and
					 resulting in physical or mental injury that directly resulted from the
					 administration of general anesthesia, deep sedation, conscious sedation or
					 nitrous oxide/oxygen analgesia by the permitholder or by a CRNA working under
					 the supervision of the permitholder. The permitholder shall submit the report
					 within 30 days of the death or incident.
(7) The Board receives prior notice of the
					 first time that a dental office of the permitholder will be used for the
					 administration of general anesthesia, deep sedation, conscious sedation or
					 nitrous oxide/oxygen analgesia.
(8)
					 General anesthesia or deep sedation administered to pediatric patients by or
					 under the delegation of a general dentist is administered by a person dedicated
					 solely to the administration and monitoring of anesthesia, and the dental
					 procedures are performed by a dental licensee who is not involved in the
					 administration of the general anesthesia.
(9) Monitoring equipment and equipment used
					 to administer general anesthesia, deep sedation, conscious sedation and nitrous
					 oxide/oxygen analgesia is installed, maintained and calibrated according to the
					 equipment manufacturer's guidelines; is in proper working condition prior to
					 the administration of general anesthesia, deep sedation, conscious sedation or
					 nitrous oxide/oxygen analgesia; and monitoring equipment is being used during
					 the administration of general anesthesia.
(10) If the permitholder travels to the
					 offices of non-permitholders for the purpose of administering general
					 anesthesia, deep sedation, conscious sedation or nitrous oxide/oxygen
					 analgesia, the permitholder shall satisfactorily complete a clinical evaluation
					 and the equipment transported to the nonpermitholder dentist's office for the
					 administration of general anesthesia, deep sedation, conscious sedation or
					 nitrous oxide/oxygen analgesia by a permitholder shall satisfactorily complete
					 an inspection conducted by an approved peer evaluation organization under
					 §
												33.336b(a)
					 (relating to approved peer evaluation organizations for administering clinical
					 evaluations and office inspections) in accordance with the requirements of the
					 AAOMS Manual and AAOMS Guidelines (OMS). As part of that clinical evaluation
					 and inspection, the permitholder shall certify that each office location in
					 which general anesthesia, deep sedation, conscious sedation or nitrous
					 oxide/oxygen analgesia is administered by the permitholder has the equipment
					 required by paragraph (2) and that the staff is properly trained to handle
					 anesthesia-related emergencies.
(11) General anesthesia, deep sedation,
					 conscious sedation and nitrous oxide/oxygen analgesia is administered to adult
					 and pediatric patients in accordance with the AAOMS Guidelines and AAOMS Manual
					 (OMSs) or to adult patients in accordance with the ADA Guidelines (general
					 dentists) or to pediatric patients in accordance with the AAPD Guidelines
					 (general dentists). Conflicts between the AAOMS Guidelines, the AAOMS Manual,
					 the ADA Guidelines, or the AAPD Guidelines and this subchapter shall be
					 resolved in favor of this subchapter.
(12) Patient records are prepared, maintained
					 and retained in accordance with §
												33.209 (relating to preparing,
					 maintaining and retaining patient records).