Senate Bill 649 History
Senate Bill No. 649
(By Senators Prezioso and Minear)
[Introduced March 21, 2005; referred to the Committee
on Health and Human Resources.]
Be it enacted by the Legislature of West Virginia:
A BILL to amend the Code of West Virginia, 1931, as amended, by
adding thereto a new section, designated
to requiring dentists who administer general anesthesia to
pediatric patients to comply with certain requirements
regarding personnel, operating facilities, equipment,
monitoring procedures, recovery and discharge.
That the Code of West Virginia, 1931, as amended, be amended
by adding thereto a new section, designated
to read as
ARTICLE 4A. ADMINISTRATION OF GENERAL ANESTHESIA AND PARENTERAL
CONSCIOUS SEDATION BY DENTISTS.
§30-4A-5a. General anesthesia in pediatric patients.
(a) Personnel. -- The provision of general anesthesia requires
the following three individuals: (1) A physician or dentist who has completed an advanced training program in anesthesia or oral
and maxillofacial surgery and related subjects beyond the
undergraduate medical or dental curriculum, who is responsible for
anesthesia and monitoring of the patient; (2) a treating dentist,
responsible for the provision of dental services; and (3) other
personnel to assist the operator as necessary. Of these
individuals, the anesthetist shall be currently certified in
advanced cardiac life support or pediatric advanced life support
and the others shall be certified currently in basic life support.
When a certified registered nurse anesthetist is permitted to
function under the supervision of a dentist, the dentist is
required to have completed training in general anesthesia, as
(b) Operating facility and equipment. --
(1) Facilities. -- The practitioner who utilizes any type of
sedative or local anesthetic in a pediatric patient shall possess
appropriate training and skills and have available the proper
facilities, personnel and equipment to manage any reasonable
foreseeable emergency situation that might be experienced. All
newly installed facilities for delivering nitrous oxide and oxygen
must be checked for proper gas delivery and fail-safe function
prior to use.
(2) Equipment. -- A positive pressure oxygen delivery system
that is capable of administering greater than ninety percent oxygen at a 10 L/min flow for at least sixty minutes (650 liter, "E"
cylinder) must be available. When a self-inflating bag value mask
device is used for delivering positive pressure oxygen, a 15 L/min
flow is recommended. All equipment must be able to accommodate
children of all ages and sizes. A functional suction apparatus
with appropriate suction catheters must be immediately available.
A sphygmomanometer with cuffs of appropriate size for pediatric
patients shall be immediately available.
Inhalation sedation equipment must have the capacity for
delivering one hundred percent and never less than twenty-five
percent oxygen concentration at a flow rate appropriate to the
child's size and must have a fail-safe system that is checked and
calibrated annually. If nitrous oxide and oxygen delivery
equipment capable of delivering more than seventy-five percent
nitrous oxide and less than twenty-five percent oxygen is used, an
in-line oxygen analyzer must be used. The equipment must have an
appropriate scavenging system.
Equipment that is appropriate for the technique used and
capable of monitoring the physiologic state of the patient before,
during and after the procedure must be present. The following
equipment shall be available for all procedures administering
general anesthesia to pediatric patients: Pulse oximeter,
capnograph, precordial/pretracheal stethoscope, blood pressure
monitor, electrocardiograph (ECG), a temperature monitor, sphygmomanometer and defibrillator.
An emergency cart or kit must be readily accessible and should
include the necessary drugs and age-and-size-appropriate equipment
to resuscitate a nonbreathing and unconscious pediatric patient and
provide continuous support while the patient is being transported
to a medical facility. There should be documentation that all
emergency equipment and drugs are checked and maintained on a
regularly scheduled basis.
(c) Monitoring procedures. -- The anesthetized patient shall
be continuously monitored by the anesthesia provider. There shall
be continual monitoring of oxygen saturation by pulse oximetry and
expired carbon dioxide concentration via capnography, heart and
respiratory rates, and blood pressure, all of which shall be
recorded minimally every five minutes. The anesthesia provider
should be visualizing the patient as well as the monitors and
observing trends in the data obtained from the monitors. At no
time should the patient be unobserved by trained personnel until
discharge criteria have been met.
(d) Recovery. -- After treatment has been completed, the
patient must be observed continuously and monitored appropriately
in a suitably equipped recovery facility until the patient becomes
stable. This facility must have a functioning suction apparatus
and suction catheters of appropriate size as well as the capacity
to deliver greater than ninety percent oxygen and provide positive pressure ventilation for pediatric patients. An individual
experienced in recovery care must be in attendance at all times to
assess and record vital signs, observe the patient and ensure
airway patency. The patient must remain in the recovery facility
until cardiovascular and respiratory parameters and functions are
stable and appropriate discharge criteria have been met.
(e) Recommended discharge criteria. -- The following are
recommended discharge criteria: (1) Cardiovascular function
satisfactory and stable; (2) airway patency uncompromised and
satisfactory; (3) patient easily arousable and protective reflexes
intact; (4) state of hydration adequate; (5) patient can talk, if
applicable; (6) patient can sit unaided, if applicable; (7) patient
can ambulate, if applicable, with minimal assistance; (8) for the
child who is very young or disabled and incapable of the usually
expected responses, the presedation level of responsiveness or the
level as close as possible for that child should be achieved; and
(9) responsible individual is available.
NOTE: The purpose of this bill is to require pediatric
dentists that administer general anesthesia to pediatric patients
to comply with certain requirements for personnel, operating
facilities, equipment, monitoring procedures, recovery and
discharge. These requirements are based on the American Academy of
Pediatric Dentistry's guidelines for the elective use of
pharmacological conscious sedation, deep sedation and general
anesthesia in pediatric dental patients.
This section is new; therefore, strike-throughs and
underscoring have been omitted.