(b) The board shall issue or renew a Class IV Permit to an applicant who:
(1) Is a licensed dentist in West Virginia;
(2) Has a current Advanced Cardiac Life Support (ACLS) Certificate;
(3) Satisfies one of the following criteria:
(A) Completion of an advanced training program in anesthesia and related subjects beyond the undergraduate dental curriculum that satisfies the requirements described in Part II of the ADA Guidelines for Teaching the Comprehensive Control of Pain and Anxiety in Dentistry at the time training was commenced;
(B) Completion of an ADA or AMA accredited postdoctoral training program which affords comprehensive and appropriate training necessary to administer and manage general anesthesia, commensurate with these guidelines;
(C) In lieu of these requirements, the board may accept documented evidence of equivalent training or experience in general anesthesia.
(c) A dentist who induces general anesthesia/deep conscious sedation shall have the following facilities, properly maintained age appropriate equipment and age appropriate drugs available during the procedure and during recovery:
(1) An operating room large enough to adequately accommodate the patient on an operating table or in an operating chair and to allow an operating team of at least three individuals to freely move about the patient;
(2) An operating table or chair which permits the patient to be positioned so the operating team can maintain the patient's airway, quickly alter the patient's position in an emergency, and provide a firm platform for the administration of basic life support;
(3) A lighting system which permits evaluation of the patient's skin and mucosal color and a backup lighting system of sufficient intensity to permit completion of any operation underway in the event of a general power failure;
(4) Suction equipment which permits aspiration of the oral and pharyngeal cavities and a backup suction device which will function in the event of a general power failure;
(5) An oxygen delivery system with adequate full face mask and appropriate connectors that is capable of delivering high flow oxygen to the patient under positive pressure, together with an adequate backup system;
(6) A nitrous oxide delivery system with a fail-safe mechanism that will insure appropriate continuous oxygen delivery and a scavenger system;
(7) A recovery area that has available oxygen, adequate lighting, suction and electrical outlets. The recovery area can be the operating room;
(8) Sphygmomanometer, pulse oximeter, electrocardiograph monitor, defibrillator or automated external defibrillator, laryngoscope with endotracheal tubes, oral and nasopharyngeal airways, intravenous fluid administration equipment;
(9) Emergency drugs including, but not limited to: Pharmacologic antagonists appropriate to the drugs used, vasopressors, corticosteroids, bronchodilators, intravenous medications for treatment of cardiac arrest, narcotic antagonist, antihistaminic, antiarrhythmics, antihypertensives and anticonvulsants; and
(10) A defibrillator device.
(d) Before inducing general anesthesia/deep conscious sedation the dentist shall:
(1) Evaluate the patient and document, using the American Society of Anesthesiologists Patient Physical Status Classifications, that the patient is an appropriate candidate for general anesthesia or deep conscious sedation;
(2) Shall give written preoperative and postoperative instructions to the patient or, when appropriate due to age or neurological status of the patient, the patient's guardian; and
(3) Shall obtain written informed consent from the patient or patient's guardian for the anesthesia.
(e) A dentist who induces general anesthesia/deep conscious sedation shall ensure that the patient's condition is monitored and recorded on a contemporaneous record. The dentist shall use a Qualified Monitor to monitor and record the patient's condition on a contemporaneous record and a chair side dental assistant. The Qualified Monitor shall hold current Heatlh Care provider BLS/CPR certification and hold certification as an Anesthesia Assistant from the American Association of Oral and Maxillofacial Surgeon Office Anesthesia Assistant certification program for Anesthesia Assistants or an equivalent. No permit holder shall have more than one patient under general anesthesia at the same time.
(f) The patient shall be monitored as follows:
(1) Patients must have continuous monitoring of their heart rate, oxygen saturation levels and respiration. At no time shall the patient be unobserved by a Qualified Monitor until discharge criteria have been met. The patient's blood pressure, heart rate and oxygen saturation shall be assessed every five minutes, and shall be contemporaneously documented in the patient record. The record must also include documentation of preoperative and postoperative vital signs, all medications administered with dosages, time intervals and route of administration. The person administering the anesthesia may not leave the patient while the patient is under general anesthesia;
(2) During the recovery phase, the patient must be monitored, including the use of pulse oximetry, by a Qualified Monitor; and
(3) A dentist may not release a patient who has undergone general anesthesia/deep conscious sedation except to the care of a responsible adult third party.
(g) The dentist shall assess the patient's responsiveness using preoperative values as normal guidelines and discharge the patient only when the following criteria are met:
(1) Vital signs including blood pressure, pulse rate and respiratory rate are stable;
(2) The patient is alert and oriented to person, place and time as appropriate to age and preoperative neurological status;
(3) The patient can talk and respond coherently to verbal questioning, or to preoperative neurological status;
(4) The patient can sit up unaided, or to preoperative neurological status;
(5) The patient can ambulate with minimal assistance, or to preoperative neurological status; and
(6) The patient does not have nausea or vomiting and has minimal dizziness.
(7) A discharge entry shall be made in the patient's record by the dentist indicating the patient's condition upon discharge and the name of the responsible party to whom the patient was discharged.
(h) A dentist who induces general anesthesia shall employ the services of a Qualified Monitor and a chair side dental assistant at all times, who each shall hold a valid BLS/CPR certification and maintains such certification. Note: WV Code updated with legislation passed through the 2012 1st Special Session
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