Conscious Sedation Requirements

Current changes to the Illinois Dental Practice Act and to the rules and regulations now dictate that a dentist who uses pharmacological agents to induce a state of sedation must possess the appropriate permit. A permit is not required for the administration of nitrous oxide unless it is used to induce a state of conscious sedation (usually in conjunction with oral sedatives).

To meet the new requirements for sedation, please consult the chart and description of approved programs in anesthesiology that would need to be completed for you to receive the appropriate permit from the Department of Professional Regulation.

Note: Dentists who need to obtain a permit will be required to complete the required training and apply for the permit by December 1, 2003.

Approved Programs in Anesthesiology

a) Conscious Sedation in the Dental Office Setting - Permit A
The anesthesiology training program shall:

1. Include a minimum of 60 hours of didactic and clinical study that includes training in conscious sedation (both light and deep), physical evaluation, venipuncture, technical administration, recognition and management of complications and emergencies, and monitoring with additionally supervised experience in providing conscious sedation to 20 or more patients; and

2. Be an organized sequence of study operated by one entity and completed in less than one calendar year.

b) Deep Sedation or General Anesthesia - Permit B

1. An approved training program in anesthesiology to administer deep sedation or general anesthesia shall be 2 (two) calendar years that includes a minimum of 200 hours of didactic and 2,000 hours of clinical training.

2. The didactic aspect may precede the clinical training or it may be offered in an integrated manner. The trainee must receive the equivalent of 2 (two) calendar years, on a consecutive basis, not to exceed 3 years, as the minimum required to provide an acceptable clinical and didactic program in comprehensive pain control. Both lectures and seminars are appropriate for providing the didactic training.

Definitions

"Anxiolysis or Mood Altering Sedation" means a pharmacologically induced, altered state of consciousness (altered mood, reduced anxiety) where an individual is awake but has decreased anxiety to facilitate coping skills, retaining interaction ability.

"Conscious Sedation" means a pharmacologically induced depressed state of consciousness (altered consciousness, signs of sleep) under which an individual retains the ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal commands.

"Deep Sedation" means a controlled state of depressed consciousness, accompanied by partial loss of protective reflexes, including inability to respond purposefully to verbal command, produced by a pharmacologic method.

"General Anesthesia" means a controlled state of unconsciousness accompanied by a partial or complete loss of protective reflexes, including inability to independently maintain an airway and respond purposefully to physical stimulation or verbal command, produced by a pharmacologic method.

FACTORS ANXIOLYSIS (No Permit Required) CONSCIOUS SEDATION (Permit A) DEEP SEDATION (Permit B) GENERAL ANESTHESIA (Permit B)
Goal Decrease anxiety; facilitate coping skills Decrease or eliminate anxiety; facilitate coping skills Eliminate anxiety; coping skills over-ridden Eliminate cognitive, sensory, and skeletal motor activity
Defination Pharmacologically induced, altered state of consciousness (altered mood; reduced anxiety) where an individual is awake but has decreased anxiety to facilitate coping skills, retaining interaction ability Pharmacologically induced state of depressed consciousness (altered consciousness, signs of sleep) under which an individual retains the ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal commands Pharmacologically induced controlled state of depressed consciousness, accompanied by partial loss of protective reflexes, including inability to respond purposefully to verbal command Pharmacologically induced controlled state of unconsciousness accompanied by a partial or complete loss of protective reflexes, including inability to independently maintain an airway and respond purposefully to physical stimulation or verbal command
Personnel 1 (treating dentist) 3 (treating dentist with Permit A; trained person to monitor patient or nurse anesthetist; trained assistant)
OR
3 (treating dentist w/o Permit A/B; physician or dentist with Permit A/B; trained assistant)
3 (treating dentist with Permit B; trained person to monitor patient or nurse anesthetist; trained assistant)
OR
3 (treating dentist w/o Permit B; physician or dentist with Permit B; trained assistant)
3 (treating dentist with Permit B; trained person to monitor patient or nurse anesthetist; trained assistant)
OR
3 (treating dentist w/o Permit B; physician or dentist with Permit B; trained assistant)
Monitoring Clinical observation and monitoring as appropriate Preoperative, intraoperative and pre-discharge monitoring of BP, pulse respiration and oxygen saturation Preoperative, intraoperative, and pre-discharge monitoring of BP, pulse, respiration and oxygen saturation, EKG monitoring, defibrillator required Preoperative, intraoperative, and pre-discharge monitoring of BP, pulse, respiration and oxygen saturation, EKG monitoring, defibrillator required


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