Section 1220.520  Deep Sedation and General Anesthesia in the Dental Office Setting

Deep sedation and general anesthesia must be administered by an individual qualified under this Section. (See Appendix D for characteristics of levels of anesthesia.)

a)         A licensed dentist seeking a permit to administer deep sedation or general anesthesia shall make application to the Division, on forms provided by the Division, that shall include:

1)         Certification of meeting one or more of the following:

A)        Completion of a minimum of 2 years of advanced training in anesthesiology or related academic subjects, or its equivalent, beyond the pre-doctoral level, in a training program as outlined in Part 2 of Teaching the Comprehensive Control of Pain and Anxiety in an Advanced Education Program, published by the American Dental Association, Council on Dental Education, dated December 2002.

B)        Be a diplomate of the American Board of Oral and Maxillofacial Surgery.

C)        Has a specialty license in oral and maxillofacial surgery issued by the Division.

D)        Has a current valid permit for deep sedation or general anesthesia administration issued by the Division;

2)         A signed affidavit certifying that the dentist will practice in a facility properly equipped in accordance with subsection (d) of this Section for the administration of deep sedation and general anesthesia staffed with a supervised team that includes a minimum of 2 individuals, in addition to the dentist, capable of assisting with procedures, problems and emergencies incident to the administration of such sedation (e.g., BLS); and

3)         The required fee set forth in Section 1220.415.

b)         Upon review and recommendation of the Board in accordance with the standards set forth in this Section, the Division will issue a deep sedation or general anesthesia permit (Permit B).

c)         If the accuracy, relevance or sufficiency of any submitted documentation is questioned by the Division or the Board because of discrepancies or conflicts in information needing further clarification, and/or missing information, additional documentation may be required and/or an on-site evaluation of the facilities, equipment and personnel may be conducted by the Division or a member of the Board's Advisory Panel.

d)         Each facility where deep sedation or general anesthesia is administered shall be equipped with equipment specified in Section 1220.510(g) as well as the following:

1)         Laryngoscope complete with selection of blades and spare batteries and bulbs in sizes appropriate to the patient population being served;

2)         Endotracheal tubes and connectors and face masks in sizes appropriate for the patient population being served and a device capable of delivering positive pressure ventilation;

3)         Tonsillar or pharyngeal suction tips adaptable to all office outlets;

4)         Nasal and oral airways in sizes appropriate to the patient population being served;

5)         Device for monitoring temperature (e.g., temperature strips, thermometer);

6)         Electrocardioscope and defibrillator;

7)         Pulse oximeter;

8)         Equipment for the establishment of an intravenous infusion;

9)         Emergency drugs and equipment appropriate to the medications administered;

10)         An operating table or an operating chair that permits appropriate access to the patient and provides a firm platform for the management of cardiopulmonary resuscitation;

11)         A recovery area that has available oxygen, lighting, suction and electrical outlets.  The patient should remain in the recovery area until the individual retains the ability to independently and consciously maintain an airway and respond appropriately to physical stimulation and verbal command.  The recovery area may be the operating theatre; and

12)         An emergency back-up lighting system that will permit the completion of any operation underway.

e)         The following records shall be kept when administering deep sedation and general anesthesia:

1)         Medical history and patient evaluation prior to the performance of any procedure;

2)         Preoperative, intraoperative, and pre-discharge monitoring of blood pressure, pulse, respiration and oxygen saturation;

3)         EKG monitoring during the entire procedure;

4)         Drugs and dosages of agents used during the operative procedure, including nitrous oxide and oxygen, and including identification of the person administering drugs and times of their administration over the course of the procedure.

Documentation of the anesthetic encounter will be consistent with currently accepted standards of anesthetic practice.

f)          The dentist who holds Permit B shall report adverse occurrences to the Division and the Board as required by Section 1220.405.

g)         A licensed dentist shall hold Permit B in order to perform dentistry while a licensed certified nurse anesthetist administers deep sedation or general anesthesia.  A nurse anesthetist for purposes of this Section is a licensed certified nurse anesthetist who holds a license as an advanced practice nurse under the Illinois Nursing and Advanced Practice Nursing Act [225 ILCS 65].  The dentist shall enter into a written practice agreement with the nurse anesthetist  in accordance with Section 15-25 of the Illinois Nursing and Advanced Practice Nursing Act and 68 Ill. Adm. Code 1305.

h)         Proof of 4 hours of continuing education in sedation techniques, including medications and recognition and management of complications and emergencies, is required for renewal of Permit B.

i)          A treating dentist does not need to hold Permit B to perform dentistry when another dentist, who holds Permit B, or a physician assists the treating dentist by administering deep sedation or general anesthesia.  Physician for purposes of this Section means a physician who is licensed to practice medicine in all of its branches under the Medical Practice Act of 1987 [225 ILCS 60] and is authorized to provide anesthesia services in a licensed hospital or licensed ambulatory surgical treatment center or is an anesthesiologist.  The dentist shall be prepared to provide affidavits attesting to the following if requested by the Division:

1)         BLS training;

2)         That the facility used is equipped as specified in subsection (d) of this Section;

3)         That staffing of the deep sedation or general anesthesia is with a supervised team that consists of a minimum of 2 individuals per patient, in addition to the dentist, capable of handling procedures, problems and emergencies incident to the administration of such sedation (e.g., BLS).  In addition, the dentist shall report severe adverse occurrences to the Division as set forth in Section 1220.405 and accept the responsibility for verifying certification and licensure of any licensed provider present during the deep sedation or general anesthesia of a patient receiving dental care.

(Source:  Amended at 30 Ill. Reg. 19656, effective December 18, 2006)