Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 5 - STATE BOARD OF DENTAL EXAMINERS › Chapter 110 - SEDATION AND ANESTHESIA › Section 110.1 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
Unless the context clearly indicates otherwise, the following
				  words and terms shall have the following meaning when used in this
				  chapter.
(1) Analgesia--the diminution
				or elimination of pain.
(2)
				Behavioral management--the use of pharmacological or psychological techniques,
				singly or in combination, to modify behavior to a level that dental treatment
				can be performed effectively and efficiently.
(3) Board/Agency--the Texas State Board of
				Dental Examiners, also known as the State Board of Dental Examiners, and, for
				brevity, the Dental Board, the Agency, or the Board.
(4) Child/children--a patient twelve (12)
				years of age or younger.
(5)
				Competent--displaying special skill or knowledge derived from training and
				experience.
(6) 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.
(7) Direct
				supervision--the dentist responsible for the sedation/anesthesia procedure
				shall be physically present in the facility and shall be continuously aware of
				the patient's physical status and well-being.
(8) Enteral--any technique of administration
				of sedation in which the agent is absorbed through the gastrointestinal (GI)
				tract or oral mucosa (i.e., oral, rectal, sublingual).
(9) Facility--the location where a permit
				holder practices dentistry and provides anesthesia/sedation services.
(10) Facility inspection--an on-site
				inspection to determine if a facility where the applicant proposes to provide
				anesthesia/sedation is supplied, equipped, staffed and maintained in a
				condition to support provision of anesthesia/sedation services that meet the
				minimum standard of care.
(11)
				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.
(12) Immediately
				available--on-site in the facility and available for immediate use.
(13) Incremental dosing--administration of
				multiple doses of a drug until a desired effect is reached, but not to exceed
				the maximum recommended dose (MRD).
(14) Local anesthesia--the elimination of
				sensation, especially pain, in one part of the body by the topical application
				or regional injection of a drug.
(15) Maximum recommended dose (applies to
				minimal sedation)--FDA maximum recommended dose (MRD) of a drug, as printed in
				FDA-approved labeling for unmonitored home use.
(16) Minimal sedation--a minimally depressed
				level of consciousness, produced by a pharmacological method, which 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. Medication administered for the
				purpose of minimal sedation shall not exceed the maximum doses recommended by
				the drug manufacturer. Nitrous oxide/oxygen may be used in combination with a
				single enteral drug in minimal sedation. During longer periods of minimal
				sedation in which the total amount of time of the procedures exceeds the
				effective duration of the sedative effect of the drug used, the supplemental
				dose of the sedative shall not exceed total safe dosage levels based on the
				effective half-life of the drug used. The total aggregate dose must not exceed
				one and one-half times the MRD on the day of treatment. The use of prescribed,
				previsit sedatives for children aged twelve (12) or younger should be avoided
				due to the risk of unobserved respiratory obstruction during the transport by
				untrained individuals.
(17)
				Moderate sedation--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. A Level 2 permit is required for moderate sedation
				limited to enteral routes of administration. A Level 3 permit is required for
				moderate sedation including parenteral routes of administration. In accordance
				with this particular definition, the drugs or techniques used shall 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. A patient whose only response
				is reflex withdrawal from a painful stimulus is not considered to be in a state
				of moderate sedation.
(18)
				Parenteral--the administration of pharmacological agents intravenously,
				intraosseously, intramuscularly, subcutaneously, submucosally, intranasally, or
				transdermally.
(19) Patient
				Physical Status Classification:
(A)
				ASA--American Society of Anesthesiologists
(B) ASA I--a normal health patient
(C) ASA II--a patient with mild systemic
				disease
(D) ASA III--a patient with
				severe systemic disease
(E) ASA
				IV--a patient with severe systemic disease that is a constant threat to
				life
(F) ASA V--a moribund patient
				who is not expected to survive without the operation
(G) ASA VI--a declared brain-dead patient
				whose organs are being removed for donor purposes
(H) E--emergency operation of any variety
				(used to modify ASA I - ASA VI).