Chapter 150-13 SEDATION PERMITS
Rule 150-13-.01 Conscious Sedation Permits
(1) | When the intent is minimal sedation
(anxiolysis), which is defined as a minimally depressed level of consciousness
that retains the patient's ability to independently and continuously maintain
an airway with unaffected ventilatory and cardiovascular function and respond
normally to tactile and verbal stimulation, a permit for
conscious sedation is not required.
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(2) | No dentist shall administer conscious sedation at the moderate level in Georgia in accordance with the definition of conscious sedation as defined by O.C.G.A. 43-11-1 unless such dentist possesses a permit based on a credentials review. The permits issued are Moderate Enteral Conscious Sedation or Moderate Parenteral Conscious Sedation. |
(3) | Moderate Conscious Sedation is defined as 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. |
(4) | Moderate Enteral Conscious Sedation is
any technique of administration in which the drugs are absorbed through the
gastrointestinal tract or oral mucosa, i.e. oral, rectal, and sublingual.
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(5) |
Moderate Parenteral Conscious Sedation is any technique utilizing multiple
sedation modalities, including intravenous, enteral, parenteral, and
inhalation.
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(6) |
The dentist issued a permit in either Moderate Enteral Conscious Sedation or
Moderate Parenteral Conscious Sedation shall maintain a properly equipped
facility for the administration of such sedation, staffed with appropriately
trained and supervised personnel. The facility must have equipment capable of
delivering positive pressure oxygen ventilation, a pulse oximeter, suction
equipment that allows aspiration of the oral and pharyngeal cavities, an
operating table or chair that allows for the patient to be positioned to
maintain an airway, a firm platform for cardiopulmonary resuscitation, a
fail-safe inhalation system if nitrous oxide/oxygen is used, equipment
necessary to establish intravascular access, equipment to continuously monitor
blood pressure and heart rate, appropriate emergency drugs per ACLS or PALS
protocol, a manual or automatic external defibrillator, and a recovery area
with available oxygen and suction. All of the aforementioned equipment, drugs,
and supplies must be stationary and not subject to transfer from one facility
to another. The applicant must submit verification that the facility meets the
above requirements and shall be subject to an on-site inspection. The dentist
and all support personnel must be certified in cardiopulmonary resuscitation at
the basic life support healthcare provider level given by a board approved
sponsor with update not to exceed two years per board rules
150-3-.08,
150-3-.09,
150-5-.04,
150-5-.05. Additionally, the dentist
must have current certification in advanced cardiovascular life support (ACLS)
for adult permits or pediatric advanced life support (PALS) for pediatric
permits or an appropriate dental sedation/anesthesia emergency management
course as approved by the board.
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(7) | The requirements as set forth in this rule apply to all new permit applicants upon its effective date. Current, active sedation permit holders are grandfathered for educational requirements and will have until December 31, 2011 to comply with facility requirements including monitoring and emergency equipment, drugs, and supplies, and periodic emergency training requirements for the dentist and all support personnel. |
(8) | Permit fees: As shown in the schedule of fees adopted by the Board of Dentistry. |
(9) | Renewal Fees: As shown in the schedule of fees adopted by the Board of Dentistry. |
(10) | Late Renewal Fees: As shown in the schedule of fees adopted by the Board of Dentistry. |
Rule 150-13-.02 Deep Sedation/General Anesthesia Permits
(1) | The educational requirements for a permit to use deep sedation/general anesthesia in Georgia shall be equal to those set forth in O.C.G.A. § 43-11-21.1. |
(2) | The following guidelines shall apply to
the administration of deep sedation/general anesthesia in the dental office or
a site approved by the Board:
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(3) | In all areas in which this level of
anesthesia is being conducted, the dentist shall maintain a properly equipped
facility for the administration of deep sedation/general anesthesia, staffed
with appropriately trained and supervised personnel. The facility must have
equipment capable of delivering positive pressure oxygen ventilation, a pulse
oximeter, suction equipment that allows aspiration of the oral and pharyngeal
cavity, an operating table or chair that allows for the patient to be
positioned to maintain an airway, a firm platform for cardiopulmonary
resuscitation, a fail-safe inhalation system if nitrous oxide/oxygen is used,
equipment to continuously monitor blood pressure and heart rate and rhythm, EKG
monitor, appropriate emergency drugs per ACLS protocol including reversal
agents for narcotics and/or benzodiazepines depending on which is actually
utilized, a manual or automatic external defibrillator, and a recovery area
with available oxygen and suction. The facility shall have continual monitoring
of end tidal CO2 (expired carbon dioxide) unless invalidated by the nature of
the patient, procedure or equipment. "Continual" shall mean "repeated regularly
and frequently in steady rapid succession." All of the aforementioned equipment
and supplies must be stationary and not subject to transfer from one facility
to another. The applicant must submit verification that the facility meets the
above requirements and shall be subject to an on-site inspection.
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(4) | The Georgia Board of Dentistry shall be given a written thirty (30) day advance notification of the relocation of a facility, the addition of a facility or significant changes in the facility. Changes in the method of administration of deep sedation/general anesthesia should also be brought to the attention of the Board. The permit holder shall be subject to an on-site inspection. |
(5) | The dentist must take four (4) hours of continuing education every two (2) years in pharmacology, anesthesia, emergency medicine or sedation as part of the forty (40) hour requirement for license renewal to maintain certification for the deep sedation/general anesthesia permit. Certification of this continuing education must be submitted at renewal. |
(6) | Permit fees: As shown in the schedule of fees adopted by the Board. |
(7) | Renewal fees: As shown in the schedule of fees adopted by the Board. |
(8) | Late renewal fees: As shown in the schedule of fees adopted by the Board. |
Rule 150-13-.03 Renewal of Conscious Sedation and Deep Sedation/ General Anesthesia Permits
(1) | Conscious sedation and deep sedation/general anesthesia permits shall be renewable biennially, on or prior to December 31st of all odd-numbered years, and upon payment of the renewal fee as provided in Rule 150-12-.01. The permit shall be administratively revoked for failure to renew on July 1st of the following even-numbered year. Permits, which have been administratively revoked, shall be reinstated only in the discretion of the Board, upon completion of a reinstatement application. The former permit holder may also be subject to an on-site inspection prior to renewal of the permit. |
(2) | The dentist must be certified in cardiopulmonary resuscitation at the basic and advanced levels and all support personnel who provide direct hands-on patient care must be certified in cardiopulmonary resuscitation at the basic life support level given by a board approved provider with an update not to exceed two years. |
(3) | The dentist must take four (4) hours of continuing education every 2 years to stay current on sedation/general anesthesia techniques, patient risk assessment courses, new medications, improved monitoring devices, and any other developing trends to insure that current knowledge and competency are maintained so that sedation/general anesthesia can be most safely provided. These four hours will be part of the total forty (40) hour CE requirement. |
(4) | CPR, ACLS, and PALS are required to rescue patients from untoward events and do count toward the total of forty (40) CE hours every two years, but do not satisfy the four (4) hour CE requirement referenced in subsection (3) above. |