1. How Do We Comply with all the Rules and Regulations?

2. Documentation…
All controlled substances must be stored in a securely locked, substantially constructed cabinet; entrance into storage only by authorized employee (YOU)
Must perform a drug inventory every 24 months (biennial)
Must record receipt, dispensing and disposal of all controlled substances

3. Documentation… Patient must be suitably evaluated PMH
Baseline vital signs
ASA
Airway evaluation
OSA
Smoking
Respiratory infections

4. Documentation… Preoperative Instructions Must be written
Verify NPO status
No solids for 6 hours
Clear liquids up to 2 hours
Medications as per usual
Adult escort

5. Documentation… Informed Consent (written????)
“patient or guardian must be advised of the procedure associated with the delivery of the sedation”
Must take and record initial vital signs (BP/pulse/pulse oximetry) and thereafter as appropriate
Time Oriented Anesthesia Record

6. Documentation… Time Oriented Anesthesia Record
Person administering drugs
Name of drug(s)
Dosages
Vital signs recorded in time oriented manner to drug administration

8. Documentation… Recovery and Discharge
Positive pressure O2 immediately available
Direct, continuous supervision until oxygenation/circulation stable
Patient appropriately responsive

9. Documentation… Recovery and Discharge Oxygenation Circulation Activity
Skin color
Level of consciousness

10. Documentation… Recovery and Discharge Airway patency Reflexes intact
Adequate hydration
Patient can talk, sit unaided, and ambulate
Presedation level of consciousness
Responsible adult available

12. Monitors

13. Texas State Board of Dental Examiners Regulations…
Patient must be monitored during time periods prior to operative procedure
Dentist must maintain direct supervision during the operative procedure

14. Texas State Board of Dental Examiners Regulations…
Oxygen
Color
Continuous pulse oximetry
Observation of chest excursion or auscultation of breath sounds
Circulation
Initial BP and pulse and thereafter as appropriate

15. Limitation of Pulse Oximetry…
Accurate at SaO2 > 75%
Nail polish/cold fingers
REMEMBER
Pulse oximetry is an indirect measure of ventilation
By the time the O2 saturation drops, patient has been hypoventilating  apnea for some period of time
Significantly impacted with the use of supplemental oxygen