Section R4-11-1301. General Anesthesia and Deep Sedation

A.      Before administering general anesthesia, or deep sedation by

any means, in a dental office or dental clinic, a dentist shall possess a Section 1301 permit issued by the Board. The dentist may renew a Section 1301 permit every five years by comply- ing with R4-11-1307.

B.       To obtain or renew a Section 1301 permit, a dentist shall:

1.        Submit a completed application on a form provided by the Board office that, in addition to the requirements of subsections (B)(2) and (3), and R4-11-1307, includes:

a.         General information about the applicant such as:

i.         Name;

ii.        Home and office addresses and telephone num- bers;

iii.      Limitations of practice;

iv.       Hospital affiliations;

v.        Denial, curtailment, revocation, or suspension of hospital privileges;

vi.       Denial of membership in, denial of renewal of membership in, or disciplinary action by a den- tal organization; and

vii.     Denial of licensure by, denial of renewal of licensure by, or disciplinary action by a dental regulatory body; and

b.        The dentist’s dated and signed affidavit stating that the information provided is true, and that the dentist has read and complied with the Board’s statutes and rules;

2.        On forms provided by the Board, provide a dated and signed affidavit attesting that any office or dental clinic where the dentist will administer general anesthesia or deep sedation:

a.         Contains the following properly operating equip- ment and supplies during the provision of general anesthesia and deep sedation:

i.         Emergency drugs;

ii.        Electrocardiograph monitor;

iii.      Pulse oximeter;

iv.       Cardiac  defibrillator  or   automated  external defibrillator (AED);

v.        Positive  pressure  oxygen  and  supplemental oxygen;

vi.       Suction equipment, including endotracheal, tonsillar, or pharyngeal and emergency backup medical suction device;

vii.     Laryngoscope, multiple blades, backup batter- ies, and backup bulbs;

viii.    Endotracheal tubes and appropriate connectors;

ix.       Magill forceps;

x.        Oropharyngeal and nasopharyngeal airways;

xi.       Auxiliary lighting;

xii.     Stethoscope; and

xiii.    Blood pressure monitoring device; and

b.        Maintains a staff of supervised personnel capable of handling procedures, complications, and emergency incidents. All personnel involved in administering and monitoring general anesthesia or deep sedation shall hold a current course completion confirmation in cardiopulmonary resuscitation (CPR) Health Care Provider Level;

3.        Hold a valid license to practice dentistry in this state;

4.        Maintain a current permit to prescribe and administer controlled substances in this state issued by the United States Drug Enforcement Administration; and

5.        Provide confirmation of completing coursework within the two years prior to submitting the permit application in one or more of the following:

a.         Advanced cardiac life support (ACLS) from the American Heart Association or another agency that follows the same procedures, standards, and tech- niques for training as the American Heart Associa- tion;

b.        Pediatric advanced life support (PALS) in a practice treating pediatric patients; or

c.         A recognized continuing education course in advanced airway management.

C.      Initial applicants shall meet one or more of the following con- ditions:

1.        Complete, within the three years before submitting the permit application, a full credit load, as defined by the training program, during one calendar year of training, in anesthesiology or related academic subjects, beyond the undergraduate dental school level in a training program described in R4-11-1306(A), offered by a hospital accredited by the Joint Commission on Accreditation of Hospitals Organization, or sponsored by a university accredited by the American Dental Association Commis- sion on Dental Accreditation;

2.        Be, within the three years before submitting the permit application, a Diplomate of the American Board of Oral and Maxillofacial Surgeons or eligible for examination by the American Board of Oral and Maxillofacial sur- geons, a Fellow of the American Association of Oral and Maxillofacial surgeons, a Fellow of the American Dental Society of Anesthesiology, a Diplomate of the National Dental Board of Anesthesiology, or a Diplomate of the American Dental Board of Anesthesiology; or

3.        For an applicant who completed the requirements of sub- sections (C)(1) or (C)(2) more than three years before submitting the permit application, provide the following documentation:

a.         On a form provided by the Board, a written affidavit affirming that the applicant has administered general anesthesia or deep sedation to a minimum of 25 patients within the year before submitting the permit application or 75 patients within the last five years before submitting the permit application;

b.        A copy of the general anesthesia or deep sedation permit in effect in another state or certification of military training in general anesthesia or deep seda- tion from the applicant’s commanding officer; and

c.         On a form provided by the Board, a written affidavit affirming the completion of 30 clock hours of con- tinuing education taken within the last five years as outlined in R4-11-1306(B)(1)(a) through (f).

D.      After submitting the application and written evidence of com- pliance with requirements in subsection (B) and, if applicable, subsection (C) to the Board, the applicant shall schedule an onsite evaluation by the Board during which the applicant shall administer general anesthesia or deep sedation. After the applicant completes the application requirements and success- fully completes the onsite evaluation, a Section 1301 permit shall be issued to the applicant.

1.        The onsite evaluation team shall consist of:

a.         Two dentists who are Board members, or Board des- ignees for initial applications; or

b.        One dentist who is a Board member or Board desig- nee for renewal applications.

2.        The onsite team shall evaluate the following:

a.         The availability of equipment and personnel as spec- ified in subsection (B)(2);

b.        Proper administration of general anesthesia or deep sedation to a patient by the applicant in the presence of the evaluation team;

c.         Successful responses by the applicant to oral exam- ination questions from the evaluation team about patient management, medical emergencies, and emergency medications;

d.        Proper documentation of controlled substances, that includes a perpetual inventory log showing the receipt, administration, dispensing, and destruction of controlled substances;

e.         Proper recordkeeping as specified in subsection (E) by reviewing the records generated for the patient specified in subsection (D)(2)(b); and

f.         For renewal applicants, records supporting contin- ued competency as specified in R4-11-1306.

3.        The evaluation team shall recommend one of the follow- ing:

a.         Pass. Successful completion of the onsite evalua- tion;

b.        Conditional Approval for failing to have appropriate equipment, proper documentation of controlled sub- stances, or proper recordkeeping. The applicant must submit proof of correcting the deficiencies before a permit is issued;

c.         Category 1 Evaluation Failure. The applicant must review the appropriate subject matter and schedule a subsequent evaluation by two Board Members or Board designees not less than 30 days from  the failed evaluation. An example is failure to recognize and manage one emergency;

d.        Category 2 Evaluation Failure. The applicant must complete Board approved continuing education in subject matter within the scope of the onsite evalua- tion as identified by the evaluators and schedule a subsequent evaluation by two Board Members or Board designees not less than 60 days from  the failed evaluation. An example is failure to recognize and manage more than one emergency; or

e.         Category 3 Evaluation Failure. The applicant must complete Board approved remedial continuing edu- cation with the subject matter outlined in R4-11- 1306 as identified by the evaluators and reapply not less than 90 days from the failed evaluation. An example is failure to recognize and manage an anes- thetic urgency.

4.        The onsite evaluation of an additional dental office or dental clinic in which general anesthesia or deep sedation is administered by an existing Section 1301 permit holder may be waived by the Board staff upon receipt in the Board office of an affidavit verifying compliance with subsection (D)(2)(a).

5.        A Section 1301 mobile permit may be issued if a Section 1301 permit holder travels to dental offices or dental clin- ics to provide anesthesia or deep sedation. The applicant must submit a completed affidavit verifying:

a.         That the equipment and supplies for the provision of anesthesia or deep sedation as required in subsection (B)(2)(a) either travel with the Section 1301 permit holder or are in place and in appropriate condition at the dental office or dental clinic where anesthesia or deep sedation is provided, and

b.        Compliance with subsection (B)(2)(b).

E.       A Section 1301 permit holder shall keep an anesthesia or deep sedation record for each general anesthesia and deep sedation procedure that includes the following entries:

1.        Pre-operative and post-operative electrocardiograph doc- umentation;

2.        Pre-operative, intra-operative, and post-operative pulse oximeter documentation;

3.        Pre-operative, intra-operative, and post-operative blood pressure and vital sign documentation;

4.        A list of all medications given, with dosage and time intervals, and route and site of administration;

5.        Type of catheter or portal with gauge;

6.        Indicate nothing by mouth or time of last intake of food or water;

7.        Consent form; and

8.        Time of discharge and status, including name of escort.

F.       The Section 1301 permit holder, for intravenous access, shall use a new infusion set, including a new infusion line and new bag of fluid, for each patient.

G.      The Section 1301 permit holder shall utilize supplemental oxygen for patients receiving general anesthesia or deep seda- tion for the duration of the procedure.

H.      The Section 1301 permit holder shall continuously supervise the patient from the initiation of anesthesia or deep sedation until termination of the anesthesia or deep sedation procedure and oxygenation, ventilation, and circulation are stable. The Section 1301 permit holder shall not commence with the administration of a subsequent anesthetic case until the patient is in monitored recovery or meets the guidelines for discharge.

I.        A Section 1301 permit holder may employ the following health care professionals to provide anesthesia or sedation ser- vices and shall ensure that the health care professional contin- uously supervises the patient from the administration of anesthesia or sedation until termination of the anesthesia or sedation procedure and oxygenation, ventilation, and circula- tion are stable:

1.        An allopathic or osteopathic physician currently licensed in Arizona by the Arizona Medical Board or the Arizona Board of Osteopathic Examiners who has successfully completed a residency program in anesthesiology approved by the American Council on Graduate Medical Education (ACGME) or the American Osteopathic Asso- ciation (AOA) or who is certified by either the American Board of Anesthesiology or the American Osteopathic Board of Anesthesiology and is credentialed with anes- thesia privileges through an Arizona licensed medical facility, or

2.        A Certified Registered Nurse Anesthetist (CRNA) cur- rently licensed in Arizona who provides services under the Nurse Practice Act in A.R.S. Title 32, Chapter 15.

J.        A Section 1301 permit holder may also administer parenteral sedation without obtaining a Section 1302 permit.

Historical Note

New Section R4-11-1301 renumbered from R4-11-802 and amended by final rulemaking at 5 A.A.R. 580, effec- tive February 4, 1999 (Supp. 99-1). Amended by final

rulemaking at 9 A.A.R. 1054, effective May 6, 2003 (Supp. 03-1). Amended by final rulemaking at 19 A.A.R.

341, effective April 6, 2013 (Supp. 13-1).