Section DE 11.09 - Standards of care(1) GENERAL. A dentist administering anesthesia or sedation shall be in the room to continuously monitor the patient until the patient meets the criteria for transfer to recovery and may not leave the dental office or facility until the patient meets the criteria for discharge and is discharged from the dental office or facility.(2) Preoperative preparation. Preoperative preparation for the administration of anesthesia or sedation shall include all of the following steps:(a) Determine the adequacy of the oxygen supply and equipment necessary to deliver oxygen under positive pressure.(b) Take and record the patient's baseline vital signs, including blood pressure, respiratory rate and heart rate. For the administration of general anesthesia and deep and moderate sedation, baseline vital signs include weight, height, blood pressure, heart rate, respiratory rate, blood oxygen saturation by pulse oximetry, and body temperature when appropriate. The inability to take vital signs due to the patient's behavior or condition shall be documented in the patient record.(c) Complete medical history and a focused physical evaluation.(d) Instruct the patient on specific dietary limitations based upon the sedative and anesthetic technique to be used and patient's physical status.(e) Provide preoperative instructions to the patient or, as appropriate, to the patient's parent or legal guardian.(f) Notify and require a patient to arrive and leave with a vested escort.(g) Establish and secure, where clinically indicated, an intravenous line throughout the procedure, except as provided for pediatric or special needs patients.(h) Advise the patient of fasting requirements.(3) MONITORING AND EVALUATION OF GENERAL ANESTHESIA, DEEP SEDATION OR MODERATE SEDATION. A dentist administering general anesthesia, deep sedation, or moderate sedation shall continuously monitor and evaluate all of the following:(a) Level of consciousness.(b) Oxygenation saturation by pulse oximetry.(d) Ventilation monitored by end-tidal carbon dioxide.(e) Auscultation of breath sounds by precordial or pretrachial stethoscope.(g) Heart rate and rhythm via electrocardiogram.(i) Color of mucosa, skin or blood.(j) Body temperature whenever triggering agents associated with malignant hyperthermia are administered.(4) MONITORING AND EVALUATION OF MINIMAL SEDATION. A dentist administering minimal sedation shall continuously monitor and evaluate all of the following: (a) Level of consciousness.(c) Ventilation by either auscultation of breath sounds or by verbal communication with the patient.(d) Color of mucosa, skin or blood.(e) Blood pressure, heart rate, and oxygenation saturation by pulse oximetry pre-operatively and post-operative and intraoperatively.(5) RECOVERY AND DISCHARGE. A dentist shall maintain and implement recovery and discharge procedures which include all of the following: (a) Immediate availability of oxygen and suction equipment.(b) Monitor and document the patient's blood pressure, heart rate, oxygenation and level of consciousness during recovery.(c) Determine and document that blood pressure, heart rate, level of consciousness, oxygenation, ventilation, and circulation are satisfactory for discharge.(d) Post-operative verbal and written instructions provided.(e) If a reversal agent is administered before discharge criteria have been met, the patient must be monitored until recovery is assured.(6) EQUIPMENT. A dentist administering anesthesia or sedation shall have immediately available and maintain equipment, appropriate for patients served, in good working order according to manufacturer's directions all the following equipment:(a) Alternative light source for use during power failure.(b) Automated external defibrillator.(c) Disposable syringes in assorted sizes.(d) Oxygen in a portable cylinder E tank capable of administering positive pressure ventilation via a bag-valve-mask system.(e) Sphygmomanometer and stethoscope for pediatric and adult patients.(f) Suction and backup system.(g) An operating chair capable of withstanding cardiopulmonary resuscitation or a back board.(h) Emergency airway equipment including oral and nasal airway and advanced airway devices for appropriate patient populations being served.(7) DRUGS. A dentist administering anesthesia or sedation shall be responsible to maintain and properly store drugs in current and unexpired condition and properly dispose of expired drugs. The following drugs shall be maintained in an emergency drug kit: (a) Non-enteric coated aspirin.(d) Antihypoglycemic agent.(8) EMERGENCY MANAGEMENT. A dentist administering anesthesia or sedation shall be responsible for the sedative or anesthetic management, diagnosis and treatment of emergencies related to the administration of anesthesia or sedation and for ensuring the equipment, drugs and protocols for patient rescue are immediately available.(9) ANESTHESIA RECORD. A dentist shall maintain an anesthesia record that documents all events related to the administration of the sedative or anesthetic agents, including all of the following:(a) Time-oriented anesthesia record that includes the date, names of all drugs administered, dosages, methods of administration and monitored physiological parameters.(b) Heart rate, respiratory rate, blood pressure, pulse oximetry, and end-tidal carbon dioxide measurements shall be recorded in 5-minute intervals for general anesthesia, deep and moderate sedation.(c) The duration of the procedure.(d) The individuals present during the procedure.Wis. Admin. Code Dentistry Examining Board DE 11.09
CR 04-095: cr. Register August 2006 No. 608, eff. 1-1-07.Amended by, CR 19-132: r. and recr. Register August 2020 No. 776, eff. 9-1-20; correction in (2) (e) made under s. 35.17, Stats., Register August 2020 No. 776, eff. 9/1/2020 Section DE 11.09(7) dealing with titration, has been removed from the rule in compliance with statutory restraints based on the objections by the Senate Committee on Health and the Joint Committee for Review of Administrative Rules. The Wisconsin Dentistry Examining Board intends to promulgate s. DE 11.09(7) upon resolution of those objections.