ADEA State Update

California and Texas Approve Pediatric Anesthesia Provisions

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pedanesthesiaCalifornia

The Dental Board of California (Board) discussed its final report on pediatric anesthesia on Dec. 1, 2016, in open session. After the discussion, the Board voted to approve the following recommendations: [1]

  1. The Board should continue to research the collection of high-quality pediatric dental sedation and anesthesia-related data to inform decision-making.
  2. The definitions of general anesthesia, conscious sedation and pediatric and adult oral sedation should be updated. 
  3. Changes to the sedation and anesthesia permit system:
    1. Pediatric Minimal Sedation Permit for patients under age 13.
      (This permit would replace the existing Oral Conscious Sedation for Minors permit.) 
      1. Education: To be eligible for this permit, the dentist must complete 24 hours of instruction in pediatric sedation plus one clinical case; this training must include airway management and patient rescue from moderate sedation.
      2. Administration: The limit is a single dose of a single sedative drug via the oral route, plus nitrous oxide and oxygen that is unlikely to produce a state of unintended moderate sedation. 
      3. Personnel: A minimum of one staff member, in addition to the dentist, trained in the monitoring and resuscitation of pediatric patients must be present.
    2. Pediatric Moderate Sedation permit for patients under age 13. (This permit could either be a new pediatric permit or an endorsement on an existing moderate [conscious] sedation permit.)
      1. Education: To be eligible for this permit, the dentist must have completed a Commission on Dental Accreditation (CODA)-accredited residency in pediatric dentistry or equivalent training in pediatric moderate sedation, as determined by the Board. The applicant must provide proof of completion of a sufficient number of cases to establish competency, both at the time of initial application and at renewal.
      2. Administration: Administration of the drugs utilized is unlikely to produce an unintended state of deep sedation.
      3. Personnel: The dentist and at least one member of the support staff must be trained in pediatric advanced life support and airway management, equivalent to the American Academy of Pediatrics/American Academy of Pediatric Dentistry (AAP-AAPD) Guidelines or as determined by the Board. For patients under age 7, two support staff, in addition to the dentist, must be present, and one staff member shall serve as a dedicated patient monitor.
    3. Pediatric general anesthesia permit for children under age 13. (This permit could either be a new pediatric permit or an endorsement on an existing general anesthesia permit.)
      1. Education: The dentist must have completed a CODA-accredited or equivalent residency training program that provides competency in the administration of deep sedation/general anesthesia for children under age 13. For patients under age 7, the applicant must provide proof of completion of a sufficient number of cases to establish competency, both at the time of initial application and at renewal.
      2. Personnel: For patients ages 7–13, the dentist and at least two support staff must be present. The dentist and at least one staff member must be trained in pediatric advanced life support and airway management, equivalent to the AAP-AAPD Guidelines or as determined by the Board. One staff member, trained in patient monitoring, shall be dedicated to that task. 

        For patients under age 7, there shall be at least three people present during the procedure. One person should be the practicing dentist; one person should be a general anesthesia permit holder to be solely dedicated to administering anesthesia, monitoring the patient and managing the airway through recovery; and one person should be an anesthesia support staff dedicated to the anesthesia process, who should be trained in pediatric advanced life support and airway management, equivalent to the AAP-AAPD Guidelines or as determined by the Board. 

      3. When a dedicated anesthesia provider is used in addition to the dentist, both the dentist and at least one staff member must be trained in pediatric advanced life support and airway management, equivalent to the AAP-AAPD Guidelines or as determined by the Board.
  4. Requirements for records and equipment should be updated and include the use of capnography for moderate sedation. 
  5. The Board should be provided with additional authority to strengthen the onsite inspection and evaluation program.

The compiled information was submitted to the California State Legislature by Jan. 1, 2017, in accordance with the reporting requirements of AB 2235. [2] It will then be up to the legislature to implement the recommendations.

Texas

On Dec. 16, the Texas Board of Dental Examiners (Board) published in the Texas Register proposed rules establishing new guidelines and permits for providing sedation and anesthesia. Comments on the proposed rules may be submitted by Jan. 31. Also, on Dec. 16, the Board published adopted rules  allowing the Board to establish an advisory committee, Blue Ribbon Panel, on dental sedation and anesthesia safety.

On Jan. 11, the Texas Sunset Advisory Commission will hear a presentation from the Blue Ribbon Panel tasked with reviewing de-identified data, including confidential investigative information related to dental anesthesia deaths and mishaps over the last five years, as well as evaluating emergency protocols. [3] The panel will present its findings and make recommendations for the Commission to consider.


[1]The final pediatric anesthesia report along with a list of recommended changes to enhance the current statutes and regulations was sent to select members of the California Legislature for their review. See footnote #2 for additional information.

[2]AB 2235 declares the Legislature’s intent that the Dental Board of California encourage dental sedation providers in the state to submit data regarding pediatric sedation events to a research database in order to improve the quality of services provided to pediatric dental anesthesia patients, as specified; and requires the Board, on or before Jan. 1, 2017, to provide a report to the Legislature on whether current statutes and regulations for the administration and monitoring of pediatric anesthesia in dentistry provides adequate protection of pediatric dental patients.

[3]The Texas Sunset Commission is charged with monitoring state agency performance. The Sunset process has streamlined and changed state government.  Since Sunset’s inception in 1977, 83 agencies have been abolished, including 37 agencies that were completely abolished and 46 that were abolished with certain functions transferred to existing or newly created agencies.

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