Introduced Version House Bill 2951 History

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H. B. 2951

(By Delegates Mahan and Staton)

[Introduced March 9, 2005 ; referred to the

Committee on Health and Human Resources then the Judiciary.]

A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new section, designated §30-4A-5a , relating to requiring dentists that administer general anesthesia to pediatric patients to comply with certain requirements regarding personnel, operating facilities, equipment, monitoring procedures, recovery and discharge.

Be it enacted by the Legislature of West Virginia:

That the Code of West Virginia, 1931, as amended, be amended by adding thereto a new section, designated §30-4A-5a, to read as follows:


§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 specified above.
(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.
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