64B5-14.008. Requirements for General Anesthesia or Deep Sedation: Operatory, Recovery Room, Equipment, Medicinal Drugs, Emergency Protocols, Records, and Continuous Monitoring  


Effective on Sunday, March 9, 2014
  • 1General Anesthesia Permit applicants and permit holders shall comply with the following requirements at each location where anesthesia procedures are performed. The requirements shall be met and equipment permanently maintained and available at each location.

    36(1) Operatory: The operatory where anesthesia is to be administered must:

    47(a) Be of adequate size and design to permit physical access of emergency equipment and personnel and to permit effective emergency management;

    69(b) Be equipped with a chair or table adequate for emergency treatment, including a chair or cardiopulmonary resuscitation (CPR) board suitable for CPR;

    92(c) Be equipped with suction and backup suction equipment, also including suction catheters and tonsil suction.

    108(2) Recovery Room: If a recovery room is present, it shall be equipped with suction and back up suction equipment, positive pressure oxygen and sufficient light to provide emergency treatment. The recovery room shall also be of adequate size and design to allow emergency access and management. The recovery room shall be situated to allow the patient to be observed by the dentist or an office team member at all times.

    179(3) Standard Equipment: The following equipment must be readily available to the operatory and recovery room and maintained in good working order:

    201(a) A positive pressure oxygen delivery system and backup system, including full face mask for adults and for pediatric patients, if pediatric patients are treated;

    226(b) Oral and nasal airways of various sizes;

    234(c) Blood pressure cuff and stethoscope;

    240(d) Cardioscope – electrocardiograph (EKG) machine, pulse oximeter, and capnograph;

    250(e) Precordial stethoscope;

    253(f) Suction with backup suction, including suction catheters and tonsil suction;

    264(g) Thermometer (Continuous temperature monitoring device, if volatile gases are used);

    275(h) A backup lighting system; and

    281(i) A scale to weigh patients.

    287(4) Emergency Equipment: The following emergency equipment must be present, readily available and maintained in good working order:

    305(a) Appropriate I.V. set-up, including appropriate supplies and fluids;

    314(b) Laryngoscope with spare batteries and spare bulbs;

    322(c) McGill forceps, endotracheal tubes, and stylet;

    329(d) Appropriate syringes;

    332(e) Tourniquet and tape;

    336(f) CPR board or chair suitable for CPR;

    344(g) Defibrillator equipment appropriate for the patient population being treated;

    354(h) Cricothyrotomy equipment; and

    358(i) A Supraglottic Airway Device (SAD) or a Laryngeal Mask Airway (LMA).

    370(5) Medicinal Drugs: The following drugs or type of drugs with a current shelf life must be maintained and easily accessible from the operatory and recovery room:

    397(a) Epinephrine;

    399(b) A narcotic (e.g., Naloxone) and benzodiazepine (e.g., Flumazenil) antagonist, if these agents are used;

    414(c) An antihistamine (e.g., Diphenhydramine);

    419(d) A corticosteroid (e.g., Dexamethasone);

    424(e) Nitroglycerin;

    426(f) A bronchodilator (e.g., Albuterol inhaler);

    432(g) An antihypoglycemic agent (e.g., D50W IV solution);

    440(h) Amiodarone;

    442(i) A vasopressor (e.g., Ephedrine);

    447(j) An anticonvulsant (e.g., Valium or Versed);

    454(k) Antihypertensive (e.g., Labetalol);

    458(l) Anticholinergic (e.g., atropine);

    462(m) Antiemetic;

    464(n) A muscle relaxant (e.g., Succinylcholine);

    470(o) An appropriate antiarrhythmic medication (e.g., Lidocaine);

    477(p) Adenosine; and

    480(q) Dantrolene, if volatile gases are used.

    487(6) Emergency Protocols: The applicant or permit holder shall provide written emergency protocols, and shall provide training to familiarize office personnel in the treatment of the following clinical emergencies:

    516(a) Laryngospasm;

    518(b) Bronchospasm;

    520(c) Emesis and aspiration;

    524(d) Airway blockage by foreign body;

    530(e) Angina pectoris;

    533(f) Myocardial infarction;

    536(g) Hypertension/Hypotension;

    538(h) Hypertensive crisis;

    541(i) Allergic and toxicity reactions;

    546(j) Seizures;

    548(k) Syncope;

    550(l) Phlebitis;

    552(m) Intra-arterial injection;

    555(n) Hyperventilation/Hypoventilation;

    557(o) Cardiac arrest; and

    561(p) Cardiac arrhythmias.

    564The applicant or permit holder shall maintain for inspection a permanent record, which reflects the date, time, duration, and type of training provided to named personnel.

    590(7) Records: The following records are required when general anesthesia or deep sedation is administered:

    605(a) The patient’s current written medical history, including known allergies and previous surgery;

    618(b) Physical examination including airway evaluation and risk assessment (e.g., Mallampati Classification, Body Mass Index, and ASA Classification);

    636(c) Base line vital signs, including blood pressure, and pulse; and

    647(d) An anesthesia record which shall include:

    6541. Continuous monitoring of vital signs, which are taken and recorded at a minimum of every 5 minute intervals during the procedure;

    6762. Drugs administered during the procedure, including route of administration, dosage, time and sequence of administration;

    6923. Duration of the procedure;

    6974. Documentation of complications or morbidity (See Rule 70564B5-14.006, 706F.A.C., for Adverse Incident Reporting Requirements);

    7125. Status of patient upon discharge, and to whom the patient is discharged; and

    7266. Names of participating personnel.

    731(8) Continuous Monitoring: The patient who is administered drug(s) for general anesthesia or deep sedation must be continuously monitored intra-operatively by electrocardiograph (EKG), pulse oximeter, and capnograph to provide heart rhythm and rate, oxygen saturation of the blood, and ventilations (end-tidal carbon dioxide). This equipment shall be used for each procedure.

    782Rulemaking Authority 784466.004, 785466.017 FS. 787Law Implemented 789466.017 FS. 791History–New 10-24-88, Amended 11-16-89, Formerly 21G-14.008, Amended 12-20-93, Formerly 61F5-14.008, Amended 8-8-96, Formerly 59Q-14.008, Amended 5-31-00, 6-23-04, 9-14-05, 3-23-06, 10-24-11, 3-9-14.

     

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