SUBCHAPTER 16Q - GENERAL ANESTHESIA AND SEDATION
SECTION .0100 GENERAL
21 NCAC 16Q .0101 GENERAL ANESTHESIA AND SEDATION DEFINITIONS
For the purpose of these Rules relative to the administration of minimal conscious sedation, moderate conscious sedation, moderate pediatric conscious sedation, or general anesthesia by or under the direction of a dentist, the following definitions shall apply:
(1) "Analgesia" the diminution or elimination of pain.
(2) "Anti-anxiety sedative" a sedative agent administered in a dosage intended to reduce anxiety without diminishing consciousness or protective reflexes.
(3) "Anxiolysis" pharmacological reduction of anxiety through the administration of a single dose of a minor psychosedative, possibly in combination with nitrous oxide, to children or adults prior to commencement of treatment on the day of the appointment that allows for uninterrupted interactive ability in an awake patient with no compromise in the ability to maintain a patent airway independently and continuously. Nitrous oxide may be administered in addition to the minor psychosedative without constituting multiple dosing for purpose of these Rules.
(4) "ACLS" Advanced Cardiac Life Support.
(5) "Administer" to direct, manage, supervise, control, and have charge of all aspects of selection, dosage, timing, and method of delivery to the patient of any pharmacologic agent intended to reduce anxiety or depress consciousness.
(6) "ASA" American Society of Anesthesiologists.
(7) "Auxiliaries" non-dentist staff members involved in general anesthesia or sedation procedures.
(8) "BLS" Basic Life Support.
(9) "Behavior control" the use of pharmacological techniques to control behavior to a level that dental treatment may be performed without injury to the patient or dentist.
(10) "Behavioral management" the use of pharmacological or psychological techniques, singly or in combination, to modify behavior to a level that dental treatment may be performed without injury to the patient or dentist.
(11) "Competent" displaying special skill or knowledge derived from training and experience.
(12) "Conscious sedation" - an induced state of a depressed level of consciousness that retains the patient's ability to maintain an airway without assistance and respond to physical stimulation and verbal commands, and that is produced by pharmacologic or non-pharmacologic agents, or a combination thereof. All dentists who perform conscious sedation shall have an unexpired sedation permit from the Dental Board.
(13) "CRNA" Certified Registered Nurse Anesthetist.
(14) "Deep sedation" an induced state of a depressed level of consciousness accompanied by partial loss of protective reflexes, including the ability to maintain an airway without assistance or respond to verbal command, produced by pharmacological agents. All dentists who perform deep sedation shall have an unexpired general anesthesia permit from the Dental Board.
(15) "Deliver" to assist a permitted dentist in administering sedation or anesthesia drugs by providing the drugs to the patient pursuant to a direct order from the dentist and while under the dentist's direct supervision.
(16) "Direct supervision" the dentist responsible for the sedation or anesthesia procedure shall be immediately available and shall be aware of the patient's physical status and well being at all times.
(17) "Emergencies manual" a written manual that documents:
(a) the location of all emergency equipment and medications in each facility;
(b) each staff member's role during medical emergencies; and
(c) the appropriate treatment for laryngospasm, bronchospasm, emesis and aspiration, respiratory depression and arrest, angina pectoris, myocardial infarction, hypertension, hypotension, allergic reactions, convulsions, syncope, bradycardia, hypoglycemia, cardiac arrest, and airway obstruction.
(18) "Enteral" - the administration of pharmacological agents orally, intranasally, sublingually, or rectally.
(19) "ET CO2" end tidal carbon dioxide.
(20) "Facility" the location where a permit holder practices dentistry and provides anesthesia or sedation services.
(21) "Facility inspection" an on-site inspection to determine if a facility where the applicant proposes to provide anesthesia or sedation is supplied, equipped, staffed, and maintained in a condition to support provision of anesthesia or sedation services in compliance with the Dental Practice Act set forth in Article 2 of G.S. 90 and the Board's rules of this Chapter.
(22) "General anesthesia" - the intended controlled state of a depressed level of consciousness that is produced by pharmacologic agents and accompanied by a partial or complete loss of protective reflexes, including the ability to maintain an airway and respond to physical stimulation and verbal commands. All dentists who perform general anesthesia shall have an unexpired general anesthesia permit from the Dental Board.
(23) "Good standing" a licensee whose license is not suspended or revoked and who is not subject to a current disciplinary order imposing probationary terms.
(24) "Immediately available" on-site in the facility and available for use without delay.
(25) "Itinerant general anesthesia provider"- a permittee who has complied with Rule .0206 of this Subchapter and who administers general anesthesia at another practitioner's facility.
(26) "Local anesthesia" the elimination of sensations, including pain, in one part of the body by the regional application or injection of a drug.
(27) "Minimal conscious sedation" conscious sedation characterized by a minimally depressed level of consciousness, in which the patient retains the ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command, provided to patients 13 years or older, by oral or rectal routes of administration of a single pharmacological agent, in one or more doses, not to exceed the manufacturer's maximum recommended dose, at the time of treatment, possibly in combination with nitrous oxide. Minimal conscious sedation may be provided for behavioral management.
(28) "Minor psychosedative/Minor tranquilizer" pharmacological agents that allow for uninterrupted interactive ability in a patient with no compromise in the ability to maintain a patent airway continuously and without assistance and carry a margin of safety wide enough to render unintended loss of consciousness unlikely.
(29) "Moderate conscious sedation" conscious sedation characterized by a drug induced depression of consciousness, during which patients respond to verbal commands, either alone or accompanied by light tactile stimulation, provided to patients 13 years of age or older, by oral, nasal, rectal, or parenteral routes of administration of single or multiple pharmacological agents, in single or multiple doses, within a 24 hour period, including the time of treatment, possibly in combination with nitrous oxide. Moderate conscious sedation may be provided for behavior control by licensed dentists who comply with the terms of Rule .0301 of this Subchapter. A moderate conscious sedation provider shall not use the following:
(a) drugs designed by the manufacturer for use in administering general anesthesia or deep sedation; or
(b) drugs contraindicated for use in moderate conscious sedation.
(30) "Moderate pediatric conscious sedation" - conscious sedation characterized by a drug induced depression of consciousness, during which patients respond to verbal commands, either alone or accompanied by light tactile stimulation, provided to patients up to 18 years of age, or special needs patients, by oral, nasal, rectal, or parenteral routes of administration of single or multiple pharmacological agents, in single or multiple doses, within a 24 hour period, including the time of treatment, possibly in combination with nitrous oxide. Moderate pediatric conscious sedation may be provided for behavior control by licensed dentists who comply with the terms of Rule .0404 of this Subchapter. A moderate pediatric conscious sedation permit holder shall not use the following:
(a) drugs designed by the manufacturer for use in administering general anesthesia or deep sedation; or
(b) drugs contraindicated for use in moderate pediatric conscious sedation.
(31) "Parenteral" - the administration of pharmacological agents intravenously, intraosseously, intramuscularly, subcutaneously, submucosally, intranasally, or transdermally.
(32) "PALS" Pediatric Advanced Life Support.
(33) "Protective reflexes" includes the ability to swallow and cough.
(34) "RN" Registered Nurse licensed by the North Carolina Board of Nursing.
(35) "Sedation Procedure" process begins when any pharmacological agent is first administered to a patient to induce general anesthesia or sedation and continues until the dentist permit holder determines that the patient has met the recovery and discharge criteria set forth in the applicable rules in this Subchapter.
(36) "Special needs patients" patients with diminished mental and or physical capacity who are unable to cooperate to receive ambulatory dental care without sedation or anesthesia.
(37) "Supplemental dosing" the oral administration of a pharmacological agent that results in an enhanced level of conscious sedation when added to the primary sedative agent administered for the purpose of oral moderate conscious sedation, and when added to the primary agent, does not exceed the maximum safe dose of either agent, separately or synergistically.
(38) "Vested adult" a responsible adult who is the legal parent or guardian, or designee of a legal parent or guardian, entrusted with the care of a patient following the administration of general anesthesia or conscious sedation.
History Note: Authority G.S. 90-30.1; 90-48;
Eff. February 1, 1990;
Temporary Amendment Eff. December 11, 2002;
Amended Eff. June 1, 2017; July 3, 2008; August 1, 2004;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.