Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OFFICE-BASED SURGERY RULES › Section 246-919-601 - Safe and effective analgesia and anesthesia administration in office-based surgical settings

Current through Register Vol. 24-14, July 15, 2024
(1) Purpose. The
				  purpose of this rule is to promote and establish consistent standards,
				  continuing competency, and to promote patient safety. The commission
				  establishes the following rule for physicians licensed under this chapter who
				  perform surgical procedures and use anesthesia, analgesia or sedation in
				  office-based settings.
(2)
				  Definitions. The following terms used in this subsection apply throughout this
				  section unless the context clearly indicates otherwise:
(a) "Deep sedation" or "analgesia" means 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.
(b) "General anesthesia" means a
				  state of unconsciousness intentionally produced by anesthetic agents, with
				  absence of pain sensation over the entire body, in which the patient is without
				  protective reflexes and is unable to maintain an airway, and cardiovascular
				  function may be impaired. Sedation that unintentionally progresses to the point
				  at which the patient is without protective reflexes and is unable to maintain
				  an airway is not considered general anesthesia.
(c) "Local infiltration" means the process of
				  infusing a local anesthetic agent into the skin and other tissues to allow
				  painless wound irrigation, exploration and repair, and other procedures,
				  including procedures such as retrobulbar or periorbital ocular blocks only when
				  performed by a board eligible or board certified ophthalmologist. It does not
				  include procedures in which local anesthesia is injected into areas of the body
				  other than skin or muscle where significant cardiovascular or respiratory
				  complications may result.
(d)
				  "Major conduction anesthesia" means the administration of a drug or combination
				  of drugs to interrupt nerve impulses without loss of consciousness, such as
				  epidural, caudal, or spinal anesthesia, lumbar or brachial plexus blocks, and
				  intravenous regional anesthesia. Major conduction anesthesia does not include
				  isolated blockade of small peripheral nerves, such as digital nerves.
(e) "Minimal sedation" means a drug-induced
				  state during which patients respond normally to verbal commands. Although
				  cognitive function and coordination may be impaired, ventilatory and
				  cardiovascular functions are unaffected. Minimal sedation is limited to oral,
				  intranasal, or intramuscular medications.
(f) "Moderate sedation" or "analgesia" means
				  a drug-induced depression of consciousness during which patients respond
				  purposefully to verbal commands, either alone or accompanied by tactile
				  stimulation. No interventions are required to maintain a patent airway, and
				  spontaneous ventilation is adequate. Cardiovascular function is usually
				  maintained.
(g) "Office-based
				  surgery" means any surgery or invasive medical procedure requiring analgesia or
				  sedation, including, but not limited to, local infiltration for tumescent
				  liposuction, performed in a location other than a hospital or
				  hospital-associated surgical center licensed under chapter 70.41 RCW, or an
				  ambulatory surgical facility licensed under chapter 70.230 RCW.