[ 448-29] Administration of general anesthesia and sedation; requirements. (a) A licensed dentist shall administer general anesthesia and sedation consistent with the current guidelines and recommendations of the American Dental Association Guidelines for the Use Of Sedation and General Anesthesia by Dentists; provided that for pediatric patients, a licensed dentist shall follow the American Academy of Pediatrics and American Academy of Pediatric Dentistry Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures.
Terms Used In Hawaii Revised Statutes 448-29
- board: means the board of dental examiners. See Hawaii Revised Statutes 323D-78
(b) No licensed dentist shall administer or employ another person, such as a physician or nurse anesthetist, who is otherwise qualified in this State to administer general anesthesia, deep sedation, or moderate (conscious) sedation for dental patients, unless the licensed dentist possesses a written authorization or permit from the board.
(c) A licensed dentist intending to produce a given level of sedation shall have the capability to rescue patients whose level of sedation becomes deeper than initially intended.
(d) Prior to receiving a written authorization or permit from the board to administer general anesthesia, deep sedation, or moderate (conscious) sedation, a licensed dentist shall apply to the board, pay an application fee, and submit the following:
(1) Proof of completion of the following educational training requirements:
(A) For general anesthesia and deep sedation:
(i) The applicant has completed an advanced dental education program, accredited by the Commission on Dental Accreditation and approved by the board, that provides comprehensive training necessary to administer deep sedation or general anesthesia and includes documented proficiency in Basic Life Support for Healthcare Providers and Advanced Cardiac Life Support or Pediatric Advanced Life Support as required pursuant to rules adopted by the board; and
(ii) Evidence of the comprehensive training required under clause (i) includes but is not limited to: being a diplomate of the American Board of Oral and Maxillofacial Surgery; a fellow or member of the American Association of Oral and Maxillofacial Surgeons; or completion of an American Dental Association-accredited residency in Oral and Maxillofacial Surgery or Dental Anesthesiology, and practicing in compliance with that training;
(B) For moderate (conscious) sedation:
(i) The applicant has completed a comprehensive training program at the postgraduate level that meets the moderate (conscious) sedation program objectives and content as outlined in the current American Dental Association Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students; and
(ii) The training program required under clause (i) shall be a minimum of sixty hours of instruction, include supervised management of at least twenty moderate (conscious) sedation patients with clinical experience in managing the compromised airway and establishment of intravenous access, and provide current documented proficiency in Basic Life Support for Healthcare Providers and Advanced Cardiac Life Support or Pediatric Advanced Life Support as required pursuant to rules adopted by the board; and
(C) A dentist administering general anesthesia or moderate sedation shall be required to complete the Advanced Cardiac Life Support course or, if treating pediatric patients, the Pediatric Advanced Life Support course; provided that both courses shall be completed if the dentist is treating pediatric patients and minors thirteen years or older;
(2) In lieu of the requirements of paragraph (1)(A) and (B), proof that the licensed dentist employs or works in conjunction with a physician who specializes in anesthesiology and is licensed pursuant to chapter 453, or a certified registered nurse anesthetist, who holds a license in good standing pursuant to chapter 457; provided that the physician who specializes in anesthesiology or certified registered nurse anesthetist shall remain on the premises of the dental facility until the patient is fully recovered and discharged from the facility; and
(3) Proof of the following facility and staff requirements: The applicant has a properly equipped facility for the administration of general anesthesia, deep sedation, or moderate (conscious) sedation staffed with a supervised team of auxiliary personnel capable of reasonably handling anesthesia procedures, problems, and emergencies incident to the administration of general anesthesia, deep sedation, or moderate (conscious) sedation; provided that the current version of the American Dental Association’s Guidelines for the Use of Sedation and General Anesthesia by Dentists and the most current edition of the American Association of Oral and Maxillofacial Surgeons’ Office Anesthesia Evaluation Manual are referenced as minimum standards of care; provided further that adequacy of the facility and competence of the anesthesia team may be determined by the consultants appointed by the board pursuant to section 448-30(a), and as provided in rules adopted by the board.
(e) A licensed dentist who has received a written authorization or permit pursuant to this section to administer or employ a qualified person to administer general anesthesia, deep sedation, or moderate (conscious) sedation shall renew the authorization or permit biennially and pay a biennial fee. As a condition of renewal, the licensed dentist shall show proof of the dentist’s written authorization or permit issued pursuant to this section and resuscitation plan.
(f) The board may, at any time, reevaluate the credentials, facilities, equipment, personnel, and procedures of a licensed dentist who has previously received a written authorization or permit from the board to determine if the dentist is still qualified to have a written authorization or permit. If the board determines that the licensed dentist is no longer qualified to have a written authorization or permit, it may revoke or refuse to renew the authorization or permit, after an opportunity for a hearing is given to the licensed dentist.