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

Effective on Tuesday, March 10, 2020
  • 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 size and design to accommodate the patient on a table or in an operating chair and permit an operating team consisting of at least three individuals to freely move about the patient.  An operating table or chair which permits the patient to be positioned so the operating team can maintain the airway, quickly alter patient position in an emergency, and provide a firm platform for the management of CPR;

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

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

    158(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.

    229(3) Standard Equipment: The following equipment must be readily available to the operatory and recovery room and maintained in good working order:

    251(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;

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

    284(c) Blood pressure cuff and stethoscope;

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

    300(e) Precordial stethoscope;

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

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

    325(h) A backup lighting system; and,

    331(i) A scale to weigh patients.

    337(4) Emergency Equipment: The following emergency equipment must be present, readily available and maintained in good working order:

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

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

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

    379(d) Appropriate syringes;

    382(e) Tourniquet and tape;

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

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

    404(h) Cricothyrotomy equipment; and,

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

    420(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 and must be maintained in sufficient amounts to address medical emergencies:

    458(a) Epinephrine;

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

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

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

    485(e) Nitroglycerin;

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

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

    501(h) Amiodarone;

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

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

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

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

    523(m) Antiemetic;

    525(n) A paralytic agent that is appropriate for the breakage of a laryngospasm or for the use of rapid sequence intubation;

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

    553(p) Adenosine; and,

    556(q) Dantrolene or ryanodex, if volatile gases are used.

    565(6) Emergency Protocols: The applicant or permit holder shall provide written emergency protocols, and shall annually provide training to familiarize office personnel in the treatment of the following clinical emergencies:

    595(a) Laryngospasm;

    597(b) Bronchospasm;

    599(c) Emesis and aspiration;

    603(d) Airway blockage by foreign body;

    609(e) Angina pectoris;

    612(f) Myocardial infarction;

    615(g) Hypertension/Hypotension;

    617(h) Hypertensive crisis;

    620(i) Allergic and toxicity reactions;

    625(j) Seizures;

    627(k) Syncope;

    629(l) Phlebitis;

    631(m) Intra-arterial injection;

    634(n) Hyperventilation/Hypoventilation;

    636(o) Cardiac arrest; and,

    640(p) Cardiac arrhythmias.

    643The 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 annually.

    670(7) Records: The following records are required when general anesthesia or deep sedation is administered:

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

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

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

    727(d) An anesthesia record which shall include:

    7341. Continuous monitoring of vital signs, which are taken and recorded at a minimum of every 5 minute intervals during the procedure;

    7562. Drugs administered during the procedure, including route of administration, dosage, time and sequence of administration;

    7723. Duration of the procedure, including the start and finish time of the procedure;

    7864. Documentation of complications or morbidity (See rule 79464B5-14.006, 795F.A.C., for Adverse Incident Reporting Requirements);

    8015. Status of patient upon discharge, and to whom the patient is discharged; and,

    8156. Names of participating personnel.

    820(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.

    871Rulemaking Authority 873466.004, 874466.017 FS. 876Law Implemented 878466.017 FS. 880History–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, 3-10-20.