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SB\  `&Times New RomanS77(X75+ ` hp x 5  &  d d5)1dxd'dxd<:zTop of For79(X7    5+ ` hp x 5?C%2A`Arial?  SB\  `&Times New RomanS77(X75+ ` hp x 5  5)2dxd0KS.SampleKA<6X9`(Courier NewKSB\  `&Times New RomanS0.Strong 8dl6TypewriterKA<6X9`(Courier NewKSB\  `&Times New RomanS42Variable: 8HTML MarkupB      2 0CommentB   35;AGMSY_11.1.1.1.1.1.1.1.<6X9`(Courier New\  `&Times New Roman%2A`Arial3#37=CIQYag1.a.i.(1)(a)(i)1)a)Di)P~2 2:i+003|xU 'A!X_XXX  USUS.,  _SS S @(03D?+ ` hp x X?BXXXX_#X_XXBXS#BXXXX_#X_XXBXЕ# BXXXX_  ARTICLE4A.ADMINISTRATIONOFANESTHESIABYDENTISTS. S #X_XXBX#BXXXX_#X_XXBXЅ#BXXXX_304A1.Legislativefindingsanddeclarationofpurpose.#X_XXBX# BXXXX_ + TheLegislatureherebyfindsanddeclaresthatdentistsareincreasinglyadministeringanesthesia  intheirofficesonanoutpatientbasis;thattheadministrationofanesthesiacarrieswithitan   inherentriskanddangertothepatient;that,however,theadministrationofanesthesiaonanout c  patientbasisbydentistsisnecessaryandforthegoodofthepublic;butthatbecauseofthe ;  inherentdangersintheadministrationof,itisnecessarytoinsurethatthepersonsadministering c  andsupervisingsuchanesthesiaarecompetentandtrainedinthetechniques;thatitisinthebest ;  interestsofthepublicandthedentistsofWestVirginiatoprohibitdentistsfromadministeringor  supervisingtheadministrationofanesthesiaunlessthosedentistsmeetcertainminimaltraining  andcompetencystandardsintheadministrationandsupervisionofanesthesia;andthatrequiring s adentisttoobtainaspecialcertificateorpermitbeforeheorshecanadministerorsupervise K anesthesiaisthebestmethodtopreservetheuseofanesthesiabydentistsonoutpatientsand,at #s thesametime,ensurethatsuchadministrationandsupervisionisperformedbycompetent K dentiststrainedintheuseofsuchtechniques. # #X_XXBXH#BXXXX_ #X_XXBXj #BXXXX_304A2.Definitions.#X_XXBXг # BXXXX_   (a)"Generalanesthesia"meansaninducedcontrolledstateofunconsciousnessinwhichthe "  patientexperiencescompletelossofprotectivereflexes,asevidencedbytheinabilityto [$" independentlymaintainanairway,theinabilitytorespondpurposefullytophysicalstimulation, 3&!$ ortheinabilitytorespondpurposefullytoverbalcommand."Deepconscioussedation/general  ([#& anesthesia"includespartiallossofprotectivereflexesandthepatientretainstheabilityto )3%( independentlyandcontinuouslymaintainanairway. + '* (b)"Relativeanalgesia"meansaninducedcontrolledstateofminimallydepressed -(, consciousness,producedsolelybytheinhalationofacombinationofnitrousoxideandoxygen,  orsingleoral_premedication_Ԁwithouttheadditionofnitrousoxideandoxygeninwhichthe  patientretainstheabilitytoindependentlyandcontinuouslymaintainanairwayandtorespond ` purposefullytophysicalstimulationandtoverbalcommand.Dosageoforal_premedication_Ԁisnot 8  toexceedtherecommendeddosagelimitssetbythemanufacturerforthetreatmentofanxiety,  ` insomniaorpain.  8  (c)"Conscioussedation"meansaninducedcontrolledstateofdepressedconsciousness,   producedthroughtheadministrationofnitrousoxideandoxygenand/ortheadministrationof   otheragentswhether_enteral_Ԁor_parenteral_,inwhichthepatientretainstheabilityto p independentlyandcontinuouslymaintainanairwayandtorespondpurposefullytophysical H stimulationandtoverbalcommand.  p (d)"_Anxiolysis_"or_premedication_Ԁforanxietymeansremoving,eliminatingordecreasing H anxietybytheuseofasingle_anxiolytic_Ԁoranalgesiamedicationthatisadministeredinan   amountconsistentwiththemanufacturer'scurrentrecommendeddosagefortheunsupervised  treatmentofanxiety,insomniaorpain,inconjunctionwithnitrousoxideandoxygen.Thisdoes  notincludemultipledosingorexceedingcurrentnormaldosagelimitssetbythemanufacturer X  forunsupervisedusebythepatient(athome),forthetreatmentofanxiety. 0"  (e)"CentralNervousSystemAnesthesia"meansaninducedcontrolledstateofunconsciousness $X" ordepressedconsciousnessproducedbyapharmacologicmethod. %0!$ (f)"_ACLS_"meansAdvancedCardiacLifeSupport. '#& (g)"BLS"meansBasicLifeSupport. )$( (h)"CPR"meansCardiopulmonaryResuscitation. h+&* (_i_)"HealthCareProviderBLS/CPR"meansHealthCareProviderBasicLife @-(, Support/CardiopulmonaryResuscitation.  (j)"PALS"meansPediatricAdvancedLifeSupport.  (k)"Board"meansWestVirginiaBoardofDentalExaminers. ` (l)"ADA"meanstheAmericanDentalAssociation. 8  (m)"AMA"meanstheAmericanMedicalAssociation.  ` (n)"Subcommittee"meansWestVirginiaBoardofDentalExaminersSubcommitteeonAnesthesia.  8  #X_XXBX #BXXXX_ #X_XXBX#BXXXX_304A3.   B;XBX# B;Q#B;  , ,?+ ` hp x X?, ,, ,,B+ ` hp x XB  S> ; ,M  #BXXB;##X_XXBX#BXXXX_PresumptionofDegreeofCentralNervousSystemDepression#X_XXBXC# BXXXX_.,M݌ >  Ќ ,, ,,$ XX$  B;XBX# B;#B;  , ,B+ ` hp x XB! ?+ ` hp x X?  Sq!  #BXXB;\##X_XXBXО#BXXXX_(1)Inanyhearingwhereaquestionexistsastothedegreeofcentralnervoussystemdepressiona  licenseehasinduced(i.e.,generalanesthesia/deepconscioussedation,conscioussedation,  _anxiolysis_,orrelativeanalgesia),theBoardmaybaseitsfindingson,amongotherthings,the t types,dosagesandroutesofadministrationofdrugsadministeredtothepatientandwhatresult L canreasonablybeexpectedfromthosedrugsinthosedosagesandroutesadministeredina $t patientofthatphysicalandpsychologicalstatus. L (2)Nopermitholdermayhavemorethanonepersonunderconscioussedationand/orgeneral $ anesthesia/deepconscioussedationatthesametime,exclusiveofrecovery. ! #X_XXBX#BXXXX_ #X_XXBXз!#BXXXX_304A4.#X_XXBX"# BXXXX_Ԁ#X_XXBXM"# BXXXX_RequirementforAnesthesiaCertificateorPermit#X_XXBXГ"# BXXXX_. #  (1)Nodentistmayinducecentralnervoussystemanesthesiawithoutfirsthavingobtainedan d% " anesthesiapermitundertheserulesforthelevelofanesthesiabeinginduced. <'"$ (2)Theapplicantforananesthesiapermitmustpaytheappropriatepermitfeesandrenewalfees, )d$& designatedinsectionsixofthisarticle,submitacompletedBoardapprovedapplicationand *<&( consenttoanofficeevaluation.Thefeesaretobesetinaccordancewithsectioneighteenofthisarticle. ,(* (3)Permitsshallbeissuedtocoincidewiththeapplicant'slicensingperiod.  #X_XXBX##BXXXX_ #X_XXBX&#BXXXX_304A5.ClassesofAnesthesiaCertificatesandPermits#X_XXBXO&# BXXXX_.  TheBoardshallissuethefollowingcertificatesand/orpermits: h (1)ClassIICertificate:AClass2Certificateauthorizesadentisttoinduce_anxiolysis_. @  (2)ClassIIIPermit:AClass3Permitauthorizesadentisttoinduceconscioussedationaslimited  h _enteral_Ԁ(3a)and/orcomprehensive_parenteral_Ԁ(3b),and_anxiolysis_.  @  (3)ClassIVPermit:AClass4Permitauthorizesadentisttoinducegeneralanesthesia/deep   conscioussedation,conscioussedation,and_anxiolysis_.B;XBX# B;&#B; !݌   Ќ XX   , ,?+ ` hp x X?, ,, ,,B+ ` hp x XB  Sn,+  #BXXB;)# #X_XXBX$*#BXXXX_304A6.Qualifications,StandardsApplicable,andContinuingEducation n RequirementsforAnesthesiaCertificateorPermit.B;XBX# B;+#B; ,++݌ F Ќ ,, ,,$ XX$  , ,B+ ` hp x XB! ?+ ` hp x X?  St!q!-  #BXXB;,##X_XXBX,#BXXXX_(a)RelativeAnalgesia. t (1)TheBoardshallallowadministrationofrelativeanalgesiawithoutapermitifthepractitioner: L (A)IsalicenseddentistintheStateofWestVirginia;!-c.݌ $t Ќ XX   B;XBX# B;.#B;  , ,?+ ` hp x X?, ,, ,,B+ ` hp x XB  SO,0  #BXXB;.0##X_XXBXp0#BXXXX_(B)HoldsvalidandcurrentdocumentationshowingsuccessfulcompletionofaHealth  CareProviderBLS/CPRcourse;and,0x1݌ z  Ќ ,, ,,$ XX$  B;XBX# B;1#B;  , ,B+ ` hp x XB! ?+ ` hp x X?  S"H"!3  #BXXB;2##X_XXBXA3#BXXXX_(C)Hascompletedatrainingcourseofinstructionindentalschool,continuingeducationorasa "H postgraduateintheadministrationofrelativeanalgesia. $  (2)Apractitionerwhoadministersrelativeanalgesiashallhavethefollowingfacilities, &!" equipmentanddrugsavailableduringtheprocedureandduringrecovery: (#$ (A)Anoperatingroomlargeenoughtoadequatelyaccommodatethepatientonanoperating X*%& tableorinanoperatingchairandtoallowdeliveryofageappropriatecareinanemergency 0,'( situation;  (B)Anoperatingtableorchairwhichpermitsthepatienttobepositionedsothatthepatient's  airwaycanbemaintained,quicklyalterthepatient'spositioninanemergency,andprovideafirm ` platformfortheadministrationofbasiclifesupport; 8  (C)Alightingsystemwhichpermitsevaluationofthepatient'sskinand_mucosal_Ԁcoloranda  ` backuplightingsystemofsufficientintensitytopermitcompletionofanyoperationunderwayin  8  theeventofageneralpowerfailure;   (D)Suctionequipmentwhichpermitsaspirationoftheoralandpharyngealcavities;   (E)Anoxygendeliverysystemwithadequatefullfacemasksandappropriateconnectorsthatis p capableofdeliveringhighflowoxygentothepatientunderpositivepressure,togetherwithan H adequatebackupsystem;  p (F)Anitrousoxidedeliverysystemwithafailsafemechanismthatwillinsureappropriate H continuousoxygendeliveryandascavengersystem.   (G)Allequipmentusedmustbeappropriatefortheheightandweightofthepatient.  (3)Beforeinducingnitrousoxidesedation,apractitionershall:  (A)Evaluatethepatient; X  (B)Giveinstructiontothepatientor,whenappropriateduetoageorpsychologicalstatusofthe 0"  patient,thepatient'sguardian; $X" (C)Certifythatthepatientisanappropriatecandidateforrelativeanalgesia. %0!$ (4)Apractitionerwhoadministersrelativeanalgesiashallseethatthepatient'sconditionis '#& visuallymonitored.Atalltimesthepatientshallbeobservedbytrainedpersonneluntildischarge )$( criteriahavebeenmet.TrainedpersonnelshallbecertifiedinbothadultandpediatricCPR. h+&* Documentationofcredentialsandtrainingmustbemaintainedinthepersonnelrecordsofthe @-(, trainedpersonnel.Thepatientshallbemonitoredastoresponsetoverbalstimulationandoral  _mucosal_Ԁcolor.  (5)Therecordmustincludedocumentationofallmedicationsadministeredwithdosages,time ` intervalsandrouteofadministration. 8  (6)Adischargeentryshallbemadeinthepatient'srecordindicatingthepatient'sconditionupon  ` discharge.  8  (7)Holdvalidandcurrentdocumentation:   (A)ShowingsuccessfulcompletionofaHealthCareProviderBLS/CPRcourse;and   (B)Havereceivedtrainingandbecompetentintherecognitionandtreatmentofmedical p emergencies,monitoringvitalsigns,theoperationofnitrousoxidedeliverysystemsandtheuse H ofthesphygmomanometerandstethoscope.  p (8)Thepractitionershallassessthepatient'sresponsivenessusingpreoperativevaluesasnormal H guidelinesanddischargethepatientonlywhenthefollowingcriteriaaremet:   (A)Thepatientisalertandorientedtoperson,placeandtimeasappropriatetoageand  preoperativeneurologicalstatus;  (B)Thepatientcantalkandrespondcoherentlytoverbalquestioningortopreoperative X  neurologicalstatus; 0"  (C)Thepatientcansitupunaidedorwithoutassistanceortopreoperativeneurologicalstatus; $X" (D)Thepatientcanambulatewithminimalassistanceortopreoperativeneurologicalstatus;and %0!$ (E)Thepatientdoesnothavenausea,vomitingordizziness. '#& (b)ClassIICertificate. )$( ClassIICertificate:_Anxiolysis_. h+&* (1)TheBoardshallissueaClassIICertificatetoanapplicantwho: @-(, (A)IsalicenseddentistinWestVirginia;  (B)HoldsvalidandcurrentdocumentationshowingsuccessfulcompletionofaHealthCare  ProviderBLS/CPR;and ` (C)Hascompletedaboardapprovedcourseofatleastsixhoursdidacticandclinicalofeither 8  _predoctoral_Ԁdentalschoolorpostgraduateinstruction.  ` (2)Adentistwhoinduces_anxiolysis_Ԁshallhavethefollowingfacilities,properlymaintained  8  equipmentandappropriatedrugsavailableduringtheproceduresandduringrecovery:   (A)Anoperatingroomlargeenoughtoadequatelyaccommodatethepatientonanoperating   tableorinanoperatingchairandtoallowanoperatingteamofatleasttwoindividualstofreely p moveaboutthepatient; H (B)Anoperatingtableorchairwhichpermitsthepatienttobepositionedsotheoperatingteam  p canmaintainthepatient'sairway,quicklyalterthepatient'spositioninanemergency,and H provideafirmplatformfortheadministrationofbasiclifesupport;   (C)Alightingsystemwhichpermitsevaluationofthepatient'sskinand_mucosal_Ԁcoloranda  backuplightingsystemofsufficientintensitytopermitcompletionofanyoperationunderwayin  theeventofageneralpowerfailure; X  (D)Suctionequipmentwhichpermitsaspirationoftheoralandpharyngealcavities; 0"  (E)Anoxygendeliverysystemwithadequatefullfacemaskandappropriateconnectorsthatis $X" capableofdeliveringhighflowoxygentothepatientunderpositivepressure,togetherwithan %0!$ adequatebackupsystem; '#& (F)Anitrousoxidedeliverysystemwithafailsafemechanismthatwillinsureappropriate )$( continuousoxygendeliveryandascavengersystem; h+&* (G)Arecoveryareathathasavailableoxygen,adequatelighting,suctionandelectricaloutlets. @-(, Therecoveryareacanbetheoperatingroom;  (H)Sphygmomanometer,stethoscope,andpulse_oximeter_;  (I)Emergencydrugs;and ` (J)A_defibrillator_Ԁdeviceisrecommended. 8  (K)Allequipmentandmedicationdosagesmustbeinaccordancewiththeheightandweightof  ` thepatientbeingtreated.  8  (3)Beforeinducing_anxiolysis_,adentistshall:   (A)Evaluatethepatient;   (B)Certifythatthepatientisanappropriatecandidatefor_anxiolysis_Ԁsedation;and p (C)Obtainwritteninformedconsentfromthepatientorpatient'sguardianfortheanesthesia.The H obtainingoftheinformedconsentshallbedocumentedinthepatient'srecord.  p (4)Thedentistshallmonitorandrecordthepatient'sconditionorshallusetrainedpersonnel H qualifiedasamonitortomonitorandrecordthepatient'scondition.Thetrainedpersonnelmust   haveacertificateshowingsuccessfulcompletioninthelasttwoyearsofBLS/CPRtraining.#X_XXBXР4#BXXXX_Ԁ#X_XXBXV#BXXXX_A  ClassIICertificateholdershallhavenomorethanonepersonunder_anxiolysis_Ԁatthesametime.  (5)Thepatientshallbemonitoredasfollows: X  (A)Patientsmusthavecontinuousmonitoringusingpulse_oximetry_.Thepatient'sbloodpressure, 0"  heartrate,andrespirationshallberecordedatleastoncebefore,duringandaftertheprocedure, $X" andtheserecordingsshallbedocumentedinthepatientrecord.Atalltimesthepatientshallbe %0!$ observedbytrainedpersonneluntildischargecriteriahavebeenmet.Ifthedentistisunableto '#& obtainthisinformation,thereasonsshallbedocumentedinthepatient'srecord.Therecordmust )$( alsoincludedocumentationofallmedicationsadministeredwithdosages,timeintervalsand h+&* routeofadministration. @-(, (B)Adischargeentryshallbemadebythedentistinthepatient'srecordindicatingthepatient's  conditionupondischarge.  (6)Apermitholderwhouses_anxiolysis_Ԁshallseethatthepatient'sconditionisvisually ` monitored.Thepatientshallbemonitoredastoresponsetoverbalstimulation,oral_mucosal_ 8  colorandpreoperativeandpostoperativevitalsigns.  ` (7)Thedentistshallassessthepatient'sresponsivenessusingpreoperativevaluesasnormal  8  guidelinesanddischargethepatientonlywhenthefollowingcriteriaaremet:   (A)Vitalsignsincludingbloodpressure,pulserateandrespiratoryratearestable;   (B)Thepatientisalertandorientedtoperson,placeandtimeasappropriatetoageand p preoperativeneurologicalstatus; H (C)Thepatientcantalkandrespondcoherentlytoverbalquestioning,ortopreoperative  p neurologicalstatus; H (D)Thepatientcansitupunaided,ortopreoperativeneurologicalstatus;   (E)Thepatientcanambulatewithminimalassistance,ortopreoperativeneurologicalstatus;and  (F)Thepatientdoesnothaveuncontrollablenauseaorvomitingandhasminimaldizziness.  (G)Adentistshallnotreleaseapatientwhohasundergone_anxyolysis_Ԁexcepttothecareofa X  responsibleadultthirdparty. 0"  (c)ClassIIIPermit(includesalimited(_enteral_)andacomprehensive(_parenteral_)permit); $X" ClassIIIPermit:Conscioussedationand_anxiolysis_. %0!$ (1)TheBoardshallissueorrenewaClass3Permittoanapplicantwho: '#& (A)IsalicenseddentistinWestVirginia; )$( (B)HoldsvalidandcurrentdocumentationshowingsuccessfulcompletionofaHealthCare h+&* ProviderBLS/CPRcourse,_ACLS_Ԁand/oraPALScourseiftreatingpediatricpatients;and @-(, (C)Satisfiesoneofthefollowingcriteria:  (_i_)Certificateofcompletionofacomprehensivetrainingprograminconscioussedationthat  satisfiestherequirementsdescribedinPartIIIoftheADA#X_XXBXaV#BXXXX_GuidelinesforTeachingthe ` ComprehensiveControlofPainandAnxiety#X_XXBXe#BXXXX_Ԁ#X_XXBXжe#BXXXX_inDentistry#X_XXBXe#BXXXX_Ԁatthetimetrainingwascommenced. 8  (ii)CertificateofcompletionofanADAaccreditedpostdoctoraltrainingprogramwhichaffords  ` comprehensiveandappropriatetrainingnecessarytoadministerandmanageconscioussedation,  8  commensuratewiththeseguidelines.   (iii)Inlieuoftheserequirements,theBoardmayacceptdocumentedevidenceofequivalent   trainingorexperienceinconscioussedationanesthesia: p (I)Limited(_Enteral_)Permit(3(a))musthaveaBoardapprovedcourseofatleasteighteenhours H didacticandtwenty_mentored_Ԁclinicalcases(PALSor_ACLS_Ԁcourse).  p (II)Comprehensive(_Parenteral_)Permit(3(b))musthaveaBoardapprovedcourseofatleast H sixtyhoursdidacticand_twentymentored_Ԁclinicalcases(_ACLS_Ԁcourse).   (2)Adentistwhoinducesconscioussedationshallhavethefollowingfacilities,properly  maintainedageappropriateequipmentandageappropriatemedicationsavailableduringthe  proceduresandduringrecovery: X  (A)Anoperatingroomlargeenoughtoadequatelyaccommodatethepatientonanoperating 0"  tableorinanoperatingchairandtoallowanoperatingteamofatleasttwoindividualstofreely $X" moveaboutthepatient; %0!$ (B)Anoperatingtableorchairwhichpermitsthepatienttobepositionedsotheoperatingteam '#& canmaintainthepatient'sairway,quicklyalterthepatient'spositioninanemergency,and )$( provideafirmplatformfortheadministrationofbasiclifesupport; h+&* (C)Alightingsystemwhichpermitsevaluationofthepatient'sskinand_mucosal_Ԁcoloranda @-(, backuplightingsystemofsufficientintensitytopermitcompletionofanyoperationunderwayin  theeventofageneralpowerfailure;  (D)Suctionequipmentwhichpermitsaspirationoftheoralandpharyngealcavitiesandabackup ` suctiondevicewhichwillfunctionintheeventofageneralpowerfailure; 8  (E)Anoxygendeliverysystemwithadequatefullfacemaskandappropriateconnectorsthatis  ` capableofdeliveringhighflowoxygentothepatientunderpositivepressure,togetherwithan  8  adequatebackupsystem;   (F)Anitrousoxidedeliverysystemwithafailsafemechanismthatwillinsureappropriate   continuousoxygendeliveryandascavengersystem; p (G)Arecoveryareathathasavailableoxygen,adequatelighting,suctionandelectricaloutlets. H Therecoveryareacanbetheoperatingroom;  p (H)Sphygmomanometer,pulse_oximeter_,oralandnasopharyngealairways,intravenousfluid H administrationequipment;   (I)Emergencydrugsincluding,butnotlimitedto:pharmacologicantagonistsappropriatetothe  drugsused,_vasopressors_,corticosteroids,_bronchodilators_,antihistamines,_antihypertensives_Ԁand  _anticonvulsants_;and X  (J)A_defibrillator_Ԁdevice. 0"  (3)Beforeinducingconscioussedation,adentistshall: $X" (A)Evaluatethepatientanddocument,usingthe#X_XXBXMf#BXXXX_AmericanSocietyofAnesthesiologistsPatient %0!$ PhysicalStatusClassifications#X_XXBX,v#BXXXX_,thatthepatientisanappropriatecandidateforconscious '#& sedation; )$( (B)Givewrittenpreoperativeandpostoperativeinstructionstothepatientor,whenappropriate h+&* duetoageorneurologicalstatusofthepatient,thepatient'sguardian;and @-(, (C)Obtainwritteninformedconsentfromthepatientorpatient'sguardianfortheanesthesia.  (4)Thedentistshallmonitorandrecordthepatient'sconditionorshalluseanassistantqualified  asamonitortomonitorandrecordthepatient'scondition.Aqualifiedmonitorshallbepresentto ` monitorthepatientatalltimes. 8  (5)Thepatientshallbemonitoredasfollows:  ` (A)Patientsmusthavecontinuousmonitoringusingpulse_oximetry_.Atnotimeshallthepatient  8  beunobservedbytrainedpersonneluntildischargecriteriahavebeenmet.Thetrainedpersonnel   musthaveacertificateshowingsuccessfulcompletioninthelasttwoyearsofBLS/CPRtraining   andtheAmericanAssociationofOralandMaxillofacialSurgeonOfficeAnesthesiaAssistant p certificationoranequivalent.Thepatient'sbloodpressure,heartrate,andrespirationshallbe H recordedeveryfiveminutes,andtheserecordingsshallbedocumentedinthepatientrecord.The  p recordmustalsoincludedocumentationofpreoperativeandpostoperativevitalsigns,all H medicationsadministeredwithdosages,timeintervalsandrouteofadministration.Ifthedentist   isunabletoobtainthisinformation,thereasonsshallbedocumentedinthepatient'srecord.  (B)Duringtherecoveryphase,thepatientmustbemonitoredbyaqualifiedmonitor.  (C)Adischargeentryshallbemadebythedentistinthepatient'srecordindicatingthepatient's X  conditionupondischargeandthenameoftheresponsiblepartytowhomthepatientwas 0"  discharged. $X" (6)Adentistshallnotreleaseapatientwhohasundergoneconscioussedationexcepttothecare %0!$ ofaresponsibleadultthirdparty. '#& (7)Thedentistshallassessthepatient'sresponsivenessusingpreoperativevaluesasnormal )$( guidelinesanddischargethepatientonlywhenthefollowingcriteriaaremet: h+&* (A)Vitalsignsincludingbloodpressure,pulserateandrespiratoryratearestable; @-(, (B)Thepatientisalertandorientedtoperson,placeandtimeasappropriatetoageand  preoperativeneurologicalstatus;  (C)Thepatientcantalkandrespondcoherentlytoverbalquestioning,ortopreoperative ` neurologicalstatus; 8  (D)Thepatientcansitupunaided,ortopreoperativeneurologicalstatus;  ` (E)Thepatientcanambulatewithminimalassistance,ortopreoperativeneurologicalstatus;and  8  (F)Thepatientdoesnothaveuncontrollablenauseaorvomitingandhasminimaldizziness.   (8)Adentistwhoinducesconscioussedationshallemploytheservicesofanassistantatalltimes   whoholdsavalidBLS/CPRcertificationandmaintainssuchcertification. p (9)AdentistgrantedaClassIIIPermitmustholdavalidHealthCareProviderBLS/CPRand H _ACLS_ԀcertificationforComprehensive(3(a))Permitand_ACLS_ԀorPALScertificationfor  p Limited(3(b))Permitandmaintainsuchcertification. H (d)ClassIVPermit   ClassIVPermit:generalanesthesia/deepconscioussedation,conscioussedation,and_anxiolysis_.  (1)TheBoardshallissueaClassIVPermittoanapplicantwho:  (A)IsalicenseddentistinWestVirginia; X  (B)HasacurrentAdvancedCardiacLifeSupport(_ACLS_)Certificate; 0"  (C)Satisfiesoneofthefollowingcriteria: $X" (_i_)Completionofanadvancedtrainingprograminanesthesiaandrelatedsubjectsbeyondthe %0!$ undergraduatedentalcurriculumthatsatisfiestherequirementsdescribedinPartIIoftheADA '#& #X_XXBXv#BXXXX_GuidelinesforTeachingthe#X_XXBXй#BXXXX_Ԁ#X_XXBX#BXXXX_ComprehensiveControlofPainandAnxietyinDentistry#X_XXBX_#BXXXX_Ԁatthetime )$( trainingwascommenced; h+&* (ii)CompletionofanADAorAMAaccreditedpostdoctoraltrainingprogramwhichaffords @-(, comprehensiveandappropriatetrainingnecessarytoadministerandmanagegeneralanesthesia,  commensuratewiththeseGuidelines;  (iii)Inlieuoftheserequirements,theBoardmayacceptdocumentedevidenceofequivalent ` trainingorexperienceingeneralanesthesia. 8  (2)Adentistwhoinducesgeneralanesthesia/deepconscioussedationshallhavethefollowing  ` facilities,properlymaintainedageappropriateequipmentandageappropriatedrugsavailable  8  duringtheprocedureandduringrecovery:   (A)Anoperatingroomlargeenoughtoadequatelyaccommodatethepatientonanoperating   tableorinanoperatingchairandtoallowanoperatingteamofatleastthreeindividualstofreely p moveaboutthepatient; H (B)Anoperatingtableorchairwhichpermitsthepatienttobepositionedsotheoperatingteam  p canmaintainthepatient'sairway,quicklyalterthepatient'spositioninanemergency,and H provideafirmplatformfortheadministrationofbasiclifesupport;   (C)Alightingsystemwhichpermitsevaluationofthepatient'sskinand_mucosal_Ԁcoloranda  backuplightingsystemofsufficientintensitytopermitcompletionofanyoperationunderwayin  theeventofageneralpowerfailure; X  (D)Suctionequipmentwhichpermitsaspirationoftheoralandpharyngealcavitiesandabackup 0"  suctiondevicewhichwillfunctionintheeventofageneralpowerfailure; $X" (E)Anoxygendeliverysystemwithadequatefullfacemaskandappropriateconnectorsthatis %0!$ capableofdeliveringhighflowoxygentothepatientunderpositivepressure,togetherwithan '#& adequatebackupsystem; )$( (F)Anitrousoxidedeliverysystemwithafailsafemechanismthatwillinsureappropriate h+&* continuousoxygendeliveryandascavengersystem; @-(, (G)Arecoveryareathathasavailableoxygen,adequatelighting,suctionandelectricaloutlets.  Therecoveryareacanbetheoperatingroom;  (H)Sphygmomanometer,pulse_oximeter_,electrocardiographmonitor,_defibrillator_Ԁorautomated ` external_defibrillator_,laryngoscopewith_endotracheal_Ԁtubes,oralandnasopharyngealairways, 8  intravenousfluidadministrationequipment;  ` (I)Emergencydrugsincluding,butnotlimitedto:pharmacologicantagonistsappropriatetothe  8  drugsused,_vasopressors_,corticosteroids,_bronchodilators_,intravenousmedicationsfortreatment   ofcardiacarrest,narcoticantagonist,antihistaminic,_antiarrhythmics_,_antihypertensives_Ԁand   _anticonvulsants_;and p (J)A_defibrillator_Ԁdevice. H (3)Beforeinducinggeneralanesthesia/deepconscioussedationthedentistshall:  p (A)Evaluatethepatientanddocument,usingthe#X_XXBXڊ#BXXXX_AmericanSocietyof#X_XXBX #BXXXX_Ԁ#X_XXBXb#BXXXX_AnesthesiologistsPatient H PhysicalStatusClassifications#X_XXBXШ#BXXXX_,thatthepatientisanappropriatecandidateforgeneralanesthesia   ordeepconscioussedation;  (B)Shallgivewrittenpreoperativeandpostoperativeinstructionstothepatientor,when  appropriateduetoageorneurologicalstatusofthepatient,thepatient'sguardian;and X  (C)Shallobtainwritteninformedconsentfromthepatientorpatient'sguardianforthe 0"  anesthesia. $X" (4)Adentistwhoinducesgeneralanesthesia/deepconscioussedationshallmonitorandrecord %0!$ thepatient'sconditiononacontemporaneousrecordorshalluseanassistantqualifiedasa '#& monitortomonitorandrecordthepatient'sconditiononacontemporaneousrecord.Thetrained )$( personnelmusthaveacertificateshowingsuccessfulcompletioninthelasttwoyearsof h+&* BLS/CPRtrainingandtheAmericanAssociationofOralandMaxillofacialSurgeonOffice @-(, AnesthesiaAssistantcertificationoranequivalent.Nopermitholdershallhavemorethanone  patientundergeneralanesthesiaatthesametime.  (5)Thepatientshallbemonitoredasfollows: ` (A)Patientsmusthavecontinuousmonitoringoftheirheartrate,oxygensaturationlevelsand 8  respiration.Atnotimeshallthepatientbeunobservedbytrainedpersonneluntildischarge  ` criteriahavebeenmet.Thepatient'sbloodpressure,heartrateandoxygensaturationshallbe  8  assessedeveryfiveminutes,andshallbecontemporaneouslydocumentedinthepatientrecord.   Therecordmustalsoincludedocumentationofpreoperativeandpostoperativevitalsigns,all   medicationsadministeredwithdosages,timeintervalsandrouteofadministration.Theperson p administeringtheanesthesiamaynotleavethepatientwhilethepatientisundergeneral H anesthesia;  p (B)Duringtherecoveryphase,thepatientmustbemonitored,includingtheuseofpulse H _oximetry_,byaqualifiedindividualtomonitorpatientsrecoveringfromgeneralanesthesia.   (6)Adentistshallnotreleaseapatientwhohasundergonegeneralanesthesia/deepconscious  sedationexcepttothecareofaresponsibleadultthirdparty.  (7)Thedentistshallassessthepatient'sresponsivenessusingpreoperativevaluesasnormal X  guidelinesanddischargethepatientonlywhenthefollowingcriteriaaremet: 0"  (A)Vitalsignsincludingbloodpressure,pulserateandrespiratoryratearestable; $X" (B)Thepatientisalertandorientedtoperson,placeandtimeasappropriatetoageand %0!$ preoperativeneurologicalstatus; '#& (C)Thepatientcantalkandrespondcoherentlytoverbalquestioning,ortopreoperative )$( neurologicalstatus; h+&* (D)Thepatientcansitupunaided,ortopreoperativeneurologicalstatus; @-(, (E)Thepatientcanambulatewithminimalassistance,ortopreoperativeneurologicalstatus;and  (F)Thepatientdoesnothavenauseaorvomitingandhasminimaldizziness.  (8)Adischargeentryshallbemadeinthepatient'srecordbythedentistindicatingthepatient's ` conditionupondischargeandthenameoftheresponsiblepartytowhomthepatientwas 8  discharged.  ` (9)Adentistwhoinducesgeneralanesthesiashallemploytheservicesofaqualifieddental  8  assistantwhoholdsavalidBLS/CPRcertificationandmaintainssuchcertification.   (10)AClassIVpermitholdermustholdavalidHealthCareProviderBLS/CPRand_ACLS_   certificationandmaintainsuchcertification.B;XBX# B;:#B; !3;4݌ p Ќ XX   , ,?+ ` hp x X?, ,, ,,B+ ` hp x XB  S>,  #BXXB;ޫ# #X_XXBX #BXXXX_304A7.AuthorityoftheWestVirginiaBoardofDentalExaminerstoreview, > inspectandreinspectdentistsforissuanceofpermits.#X_XXBX# BXXXX_Ԁ#X_XXBX֮# BXXXX_OnsiteinspectionbyWest  VirginiaBoardofDentalExaminers.B;XBX# B;#B; ,݌  Ќ ,, ,,$ XX$  , ,B+ ` hp x XB! ?+ ` hp x X?  S$t!!Ȱ  #BXXB;##X_XXBXϯ#BXXXX_BymakingapplicationtotheBoardforananesthesiapermit,saiddentistconsentsandauthorizes $t theBoardtoreviewhisorhercredentials,inspectorreinspecthisorherfacilities,andinvestigate L anyallegedanesthesiamortalities,misadventure,orotheradverseoccurrenceswhichtheBoard $ feelsisjustifiedinthebestinterestofthepublicandtheBoard.TheBoardshallhavethe ! authorityandrighttoconductaninofficerevieworonsiteinspectionofanydentistapplyingfor #  orholdingapermittoadministeranesthesiaatanytimetheBoarddeemsnecessary. \% " Priortoissuingapermit,theBoardhastherighttoconductanonsiteinspectionoffacility, 4'"$ equipment,andauxiliarypersonneloftheapplicanttodetermineif,infact,alltherequirements  )\$& forsuchpermithavebeenmet.Thisinspectionorevaluation,ifrequired,shallbecarriedoutby *4&( atleasttwomembersofthesubcommitteedirectlyappointedbytheBoardasprescribedin , (* sectioneightofthisarticle.Thisevaluationistobecarriedoutinamannerfollowingthe  principles,butnotnecessarilytheprocedures,setforthbythecurrenteditionoftheOffice  AnesthesiaEvaluationManualoftheWestVirginiaBoardofDentalExaminers.Onsite ` inspectionsarerequiredandshallbeperformedforallClassIII(a),III(b)andIVPermitHolders. 8  Thereafter,theBoardmayreinspectannually,atitsdiscretion,butmustperformanonsite  ` inspectionforallpermitholdersatleastonceeveryfiveyearsexceptingClassIIcertificate  8  holders.TheBoardreservestherighttoconductanonsiteinspectionwheneveritdeems   necessaryforallpermitorcertificateholders.However,allonsiteinspectionsshallbeheld   duringregularbusinesshours. p #X_XXBXЪ#BXXXX_ #X_XXBX6#BXXXX_304A8.OfficeEvaluations#X_XXBX# BXXXX_. H (1)Theinofficeevaluationshallinclude: (x (a)Observationofoneormorecasesofanesthesiatodeterminetheappropriatenessoftechnique P andadequacyofpatientevaluationandcare; ( (b)Inspectionoffacilities,equipment,drugsandrecords;and  (2)TheevaluationshallbeperformedbyateamappointedbytheBoardandshallinclude:  (a)Apermitholderwhohasthesametypeoflicenseasthelicenseetobeevaluatedandwho `  holdsacurrentanesthesiapermitinthesameclassorinahigherclassthanthatheldbythe 8"  licenseebeingevaluated; $`" (b)AmemberoftheBoard'sAnesthesiaCommittee; %8!$ (c)ClassIICertificateHoldersmaybeauditedperiodicallyasdeterminedbythecommittee;and '#& (d)ClassIIIandIVPermitholdersshallbeevaluatedonceeveryfiveyears. )$( #X_XXBXߺ#BXXXX_ #X_XXBX,#BXXXX_304A9.ReportingofDeath,SeriousComplicationsorInjury.#X_XXBXu# BXXXX_Ԁ p+&* Ifadeath,anyseriouscomplicationoranyinjuryoccurswhichmayhaveresultedfromthe P-(, administrationofgeneralanesthesia/deepconscioussedation,conscioussedation,_anxiolysis_,or  relativeanalgesia,thelicenseeperformingthedentalproceduremustsubmitawrittendetailed  reporttotheBoardwithinfivedaysoftheincidentalongwithcopiesofthepatient'soriginal ` completedentalrecords.Iftheanestheticagentwasadministeredbyapersonotherthanthe 8  personperformingthedentalprocedure,thatpersonmustalsosubmitadetailedwrittenreport.  ` Thedetailedreport(s)mustinclude:  8  (1)Name,ageandaddressofpatient;   (2)Nameofthelicenseeandotherpersonspresentduringtheincident;   (3)Addresswheretheincidenttookplace; p (4)Typeofanesthesiaanddosagesofdrugsadministeredtothepatient; H (5)Anarrativedescriptionoftheincidentincludingapproximatetimesandevolutionof  p symptoms;and H (6)Theanesthesiarecordandthesignedinformedconsentformfortheanesthesiawhenrequired.   #X_XXBX# BXXXX_ #X_XXBXР#BXXXX_#X_XXBX#BXXXX_304A10.Immunityfromliability.#X_XXBX6# BXXXX_  (a)Notwithstandinganyotherprovisionoflaw,nopersonprovidinginformationtotheBoardof X  DentalExaminersortotheSubcommitteemaybeheld,byreasonofhavingprovidedsuch 0"  information,tobecivillyliableunderanylawunlesssuchinformationwasfalseandtheperson $X" providingsuchinformationkneworhadreasontobelievethatsuchinformationwasfalse. %0!$ (b)NomemberoremployeeoftheBoardofDentalExaminersortheSubcommitteemaybeheld '#& byreasonoftheperformancebyhimorherofanyduty,functionoractivityauthorizedor )$( requiredoftheBoardortheSubcommitteetobecivillyliable.Theforegoingprovisionsofthis h+&* subsectionshallnotapplywithrespecttoanyactiontakenbyanyindividualifsuchindividual,in @-(, takingsuchaction,wasmotivatedbymalicetowardanypersonaffectedbysuchaction.B;XBX# B;#B; !ȰE݌  Ќ XX   , ,?+ ` hp x X?, ,, ,,B+ ` hp x XB  S.~+,  #BXXB;# #X_XXBX#BXXXX_304A11.Effectonpracticingdentistswhoarecurrentlyadministeringor .~ supervisinggeneralanesthesiaor_parenteral_Ԁconscioussedation.,f݌  V Ќ ,, ,,$ XX$  B;XBX# B;#B;  , ,B+ ` hp x XB! ?+ ` hp x X?  S 1 !  #BXXB;)##X_XXBXk#BXXXX_ #X_XXBX# BXXXX_Existing_parenteral_ԀconscioussedationpermitsshallbecomeClassIII(b)Permitsandgeneral \  anesthesiapermitsshallbecomeClassIVPermits.!h݌ 4  Ќ XX   B;XBX# B;##B;  X X<( ` hp x X<, ,X ,X?+ ` hp x X?  S _  X, X,?( ` hp x X?,"  #BXXB;i# #X_XXBXЫ#BXXXX_304A12.Newapplicants.B;XBX# B;t#B; ,"݌   Ќ XX XX XX  X X?+ ` hp x X?! ?+ ` hp x X?  S0-!  #BXXB;##X_XXBX#BXXXX_Ontheeffectivedateofthisarticleandfromthatdateforward,anydentistnotpreviously 0 administeringorsupervisingClass2,3or4anesthesiaortechniquesbutwishingtodoso,shall X makeapplicationtotheBoardasprescribedherein.TheBoardandtheSubcommitteeshallthen 0 reviewtheapplicant'scredentialsandfurtherwillrequireanonsiteevaluationofthedentist's  facilities,equipment,techniques,andpersonnelpriortoissuingaregularannualpermitor  certification.Aftertheinitialonsiteinspection,theBoard,atitsdiscretion,willconductfurther h onsiteevaluations.![݌ @ Ќ XX   B;XBX# B;#B;  X X<( ` hp x X<, ,X ,X?+ ` hp x X?  S!k! X, X,?( ` hp x X?,  #BXXB;# #X_XXBXW#BXXXX_304A13.Issuanceofregularannualpermits.B;XBX# B; #B; ,݌ ! Ќ XX XX XX  X X?+ ` hp x X?! ?+ ` hp x X?  S<$#9!  #BXXB;l##X_XXBXЮ#BXXXX_UpontherecommendationoftheSubcommitteetotheBoardofDentalExaminers,theBoard <$ shallissueregularpermitstoapplicabledentists.Ananesthesiapermitorcertificationmustbe &d!  renewedannuallyasdescribedinsectionfifteenofthisarticle.B;XBX# B;#B; !݌ '<#" Ќ XX   , ,?+ ` hp x X?, ,, ,,B+ ` hp x XB  Sj*%*g%,  #BXXB;# #X_XXBX#BXXXX_304A14.#X_XXBX# BXXXX_Ԁ#X_XXBX+# BXXXX_Waitingperiodfor_reapplication_Ԁorreinspectionoffacilities.B;XBX# B;q#B; ,q݌ j*%$ Ќ ,, ,,$ XX$  , ,B+ ` hp x XB! ?+ ` hp x X?  S,@(,'!*  #BXXB;##X_XXBX1#BXXXX_ ,@(& Adentistwhoseapplicationhasbeendeniedforfailuretosatisfytherequirementsinthe  applicationprocedureortheonsiteevaluationmustwaitthirtydaysfromthedateofsuchdenial  priortoreapplyingandmustsubmittoanotheronsiteevaluationpriortoreceivingaregular ` annualpermit.ItistheresponsibilityoftheBoardandtheSubcommitteetopromptlyreinspect 8  theapplicantdentist'sfacilities,techniques,equipment,andpersonnelwithinninetydaysafter  ` saidapplicanthasmade_reapplication_.B;XBX# B; #B; !*݌  8  Ќ XX   , ,?+ ` hp x X?, ,, ,,B+ ` hp x XB  Sf c ,  #BXXB;# #X_XXBX #BXXXX_304A15.ApplicationandAnnualrenewalofregularpermits;fees.B;XBX# B;#B; ,y݌ f  Ќ ,, ,,$ XX$  , ,B+ ` hp x XB! ?+ ` hp x X?  S4 !  #BXXB;F##X_XXBXЈ#BXXXX_TheBoardofDentalExaminersshallrequireaninitialapplicationfeeandanannualrenewalfee 4 forClass2CertificateandClassIIIandIVPermits.Provided,however,thatapersoncurrently   holdingageneralanesthesiaand/or_parenteral_Ԁconscioussedationpermitshallmakeapplication  withoutanapplicationfeeassetforth_hereinabove_.AllpermitsshallexpireonJune30thofevery l yearandrenewalfeesshallbedueonorbeforeJune30thofeveryyear.TheBoardshallrenew D permitsfortheuseofanesthesiaafterreceivingtherenewalfeeunlessthepermitholderhasbeen l informedinwritingwithinsixtydayspriortosuchrenewaldatethatareevaluationofhisorher D credentialsisrequired.Indeterminingwhethersuchreevaluationisnecessary,theBoardmay  considersuchfactorsasitdeemsappropriate,including,butnotlimitedtopatient,dentistor ! physiciancomplaintsandreportsofadverseoccurrenceormisadventures.Reevaluationmayalso |#  includeayearlyonsiteinspectionofthefacility,equipment,personnel,licentiateandprocedures T% " utilizedbytheholderofsuchpermit.However,anonsiteinspectionofthefacility,equipment, ,'|"$ personnel,licentiateandproceduresutilizedbytheholderofsuchapermitwillberequiredfor )T$& allClass3and4PermitHolderswithinafiveyearperiodfromthepermitholder'slastonsite *,&( inspection.B;XBX# B;c#B; !݌ ,(* Ќ XX   , ,?+ ` hp x X?, ,, ,,B+ ` hp x XB  SS,[  #BXXB;:# #X_XXBX|#BXXXX_304A16.Violationsofarticle;penaltiesforpracticinganesthesiawithouta S permit.B;XBX# B;U#B; ,[݌ + Ќ ,, ,,$ XX$  , ,B+ ` hp x XB! ?+ ` hp x X?  SY  V!  #BXXB;##X_XXBX #BXXXX_Violationsofanyoftheprovisionsofthisarticle,whetherintentionalorunintentional,mayresult Y  intherevocationorsuspensionofthedentist'spermittoadministeranesthesia;multipleor 1  repeatedviolationsorgrossinfractions,suchaspracticinganesthesiawithoutavalidpermitmay  Y resultinsuspensionofthedentist'slicensetopracticedentistryforuptooneyearaswellasother 1  disciplinarymeasuresasdeemedappropriatebytheBoardofDentalExaminers.B;XBX# B;#B; !݌   Ќ XX   , ,?+ ` hp x X?, ,, ,,B+ ` hp x XB  S74,g  #BXXB;F# #X_XXBXЈ#BXXXX_304A17.#X_XXBXa# BXXXX_Ԁ#X_XXBXЯ# BXXXX_AppointmentofSubcommitteebytheWestVirginiaBoardofDental 7 Examiners;credentialsreview;andonsiteinspections.B;XBX# B;#B; ,g݌ g Ќ ,, ,,$ XX$  , ,B+ ` hp x XB! ?+ ` hp x X?  SB!  #BXXB;##X_XXBX#BXXXX_(1)TheWestVirginiaBoardofDentalExaminersshallappointaminimumofafourmember  Subcommitteetocarryoutthereviewandonsiteinspectionofanydentistapplyingforor m renewingapermitunderthisarticle.TheSubcommitteeshallalsomakearecommendationfor E issuingorrevokingapermitunderthisarticle.ThisSubcommitteeshallbeknownasthe"West m VirginiaBoardofDentalExaminersSubcommitteeonAnesthesia,"hereinafterreferredtoasthe E "Subcommittee."TheSubcommitteeshallconsistofonememberoftheBoardofDental   ExaminerswhoshallactaschairmanoftheSubcommittee,andtwomembersholdingaClass4 " permitandtwomembersholdingaClass3permit.Further,theBoardmayappointadditional }$  memberstothisSubcommitteeprovidedtheyhavethesamecredentialssetforth_hereinabove_Ԁas U&!" necessarytocarryoutthedutiesoftheSubcommittee. -(}#$ (2)TheSubcommitteeshallhavetheauthoritytoadoptpoliciesandproceduresrelatedtothe *U%& regulationofgeneralanesthesia/deepconscioussedation,conscioussedation,_anxiolysis_,and +-'( relativeanalgesiawiththesamebeingapprovedbytheBoard.Saidsubcommitteemembersshall -)* bepaidandreimbursedexpensespursuanttoarticlefourofthischapter.  #X_XXBXн#BXXXX_#X_XXBX*# BXXXX_304A18.#X_XXBXs# BXXXX_Ԁ#X_XXBX# BXXXX_Rulemakingauthority#X_XXBX# BXXXX_.  Theboardshallproposeadditionalrulesforlegislativeapprovalinaccordancewiththe h provisionsofarticlethree,chaptertwentynineaofthiscodetoimplementtheprovisionsofthis @  articleincluding,butnotlimitedto,thefollowing:  h (a)Fees;  @  (b)Evaluations;   (c)Equipment;and   _(d)Education.__________B;XBX# B;a#B; _ S# B;0 ##X_X #