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American Association of Oral and Maxillofacial Surgeons

Government Affairs News & Materials

2007 Year-End Summary of State Anesthesia-Sedation Activity

January 17th, 2008

Several states have increased requirements for various levels of sedation.

  • Illinois enacted legislation (SB 214) to require by statute that dentists have a permit to administer deep sedation. Previously, the permit was only required by administrative rule. The new law also requires Basic Life Support BLS training for all members of the dental sedation team; the dental board rules only recommended it.

  • A newly adopted regulation in Louisiana changes a section title from "Pediatric Enteral Anesthesia" to "Conscious Sedation with Enteral Drugs," but leaves all previous requirements for administration of enteral sedation to pediatric patients unchanged. The regulation also adds a new provision for adult patients whereby the licensee must provide proof of current certification in cardiopulmonary resuscitation Course "C," Basic Life Support for the Health Care Provider as defined by the American Heart Association or its equivalent. For pediatric patients, the licensee must provide proof of current certification in Pediatric Life Support (PALS), or its equivalent.

  • Legislation died in West Virginia (HB 3055) that would have required dentists who administer general anesthesia to pediatric patients to comply with certain requirements regarding personnel, operating facilities, equipment, monitoring procedures, recovery and discharge.

  • The District of Columbia Dental Board adopted a rule amending the qualifications to administer general anesthesia, intravenous sedation and nitrous oxide to include maintaining current certification in cardiopulmonary resuscitation for healthcare providers.

  • The Minnesota Board of Dentistry adopted a rule revising the requirements for conscious sedation permits. Didactic education is now required for both enteral and parenteral administration. Personal administration and management of a specified number of individual supervised cases of parenteral sedation is also now required.

  • A new Florida rule takes the office inspection process further by requiring dentists seeking general/deep sedation, conscious sedation or pediatric conscious sedation permits to demonstrate knowledge and use of the equipment and drugs during a procedure to Board appointed consultant inspectors prior to issuance of the respective permit.

The North Carolina Dental Board is seeking to revise definitions associated with sedation. It issued a proposal that would re-define the kinds of sedation by the level of sedation induced rather than the route of administration. It would also define moderate pediatric conscious sedation, provide separate requirements for those who administer moderate pediatric conscious sedation and provide guidelines for the issuance and renewal of permits for minimal, moderate and moderate pediatric conscious sedation.

A separate North Carolina proposed rule would add a definition of complex enteral conscious sedation to include multiple doses of oral or rectal sedatives. The definition of enteral conscious sedation would be amended to limit the number of agents used to achieve conscious sedation. The amended definition would define enteral conscious sedation as that which is achieved by the oral or rectal administration of a single pharmacological agent, in one or more doses, within a twenty-four hour period; including, the time of treatment, possibly in combination with nitrous oxide. To administer complex enteral conscious sedation, applicants for this level of permit would need the same qualifications as one applying for a permit to administer parenteral conscious sedation.

Finally, states continue to address the issue of titration. Connecticut enacted legislation (HB 7163) to broaden the definition of conscious sedation so that a conscious sedation permit is now required if a dentist wishes to administer more than a single dose of any oral sedative to a patient, while legislation introduced in Wisconsin (AB 37) would prohibit the state dental board from "promulgating a rule that does any of the following: 1) prohibits a dentist from administering a dose of an oral medication to induce conscious sedation that exceeds the maximum recommended dose; or 2) prohibits a dentist who has administered such a medication from administering a subsequent dose unless a period of time sufficient for the medication to reach its peak plasma has elapsed." The bill passed the Assembly in 2007 and is awaiting action in the Senate. It is expected to be carried over into the 2008 session.