PA 15-163—HB 6937

Public Health Committee

AN ACT CONCERNING THE DEPARTMENT OF PUBLIC HEALTH'S RECOMMENDATIONS REGARDING THE DEFINITIONS OF SEDATION AND GENERAL ANESTHESIA

SUMMARY: This act updates the statutory definitions of sedation and general anesthesia related to dentistry to reflect industry standards by:

1. eliminating the definition of “conscious sedation” in the dentistry statutes and replacing it with new definitions for “minimal sedation,” “moderate sedation,” and “deep sedation;

2. updating the definition of “general anesthesia;

3. extending to dentists using moderate or deep sedation existing permitting requirements for the use of general anesthesia; and

4. exempting dentists using minimal sedation from these permitting requirements.

The act authorizes the state Dental Commission to take disciplinary action against a dentist permitted to use moderate or deep sedation who fails to successfully complete an on-site evaluation of his or her office. Among other things, this includes license revocation or suspension, censure, a letter of reprimand, or a civil penalty. (The commission may already take these actions against general anesthesia permit holders who fail to complete the evaluation. )

EFFECTIVE DATE: October 1, 2015

PERMIT REQUIREMENTS

The act extends to dentists using moderate or deep sedation existing Department of Public Health (DPH) permitting requirements for the use of general anesthesia.

By law, to obtain a permit, a dentist must (1) pay a $200 fee, (2) demonstrate compliance with American Dental Association Guidelines for Teaching and the Comprehensive Control of Pain and Anxiety in Dentistry, and (3) successfully complete an on-site evaluation of his or her office. A DPH-approved site evaluator must conduct the on-site visit in consultation with the Connecticut Society of Oral and Maxillofacial Surgeons.

DPH may renew permits annually, provided the dentist (1) pays a $200 renewal fee and (2) completes an on-site evaluation at least once every five years.

DEFINITIONS

General Anesthesia

The act defines “general anesthesia” as a drug-induced loss of consciousness during which a person:

1. is not able to be aroused, even by painful stimulation;

2. often has an impaired ability to independently maintain ventilator function;

3. often requires assistance maintaining his or her airway and may require positive pressure ventilation because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function; and

4. may have impaired cardiovascular function.

Prior law defined general anesthesia as a controlled state of unconsciousness produced by pharmacologic or nonpharmacologic methods, or a combination of the two, accompanied by a partial or complete loss of a person's protective reflexes, including an inability to independently maintain an airway and respond to physical stimulation or verbal commands.

Deep Sedation

The act defines “deep sedation” as a drug-induced depression of consciousness during which:

1. a person cannot be easily aroused but responds purposefully following repeated or painful stimulation;

2. a person's ability to independently maintain ventilator function may be impaired;

3. a person may require assistance to maintain his or her airway, and spontaneous ventilation may be inadequate; and

4. cardiovascular function is usually maintained.

Moderate Sedation

The act defines “moderate sedation” as a drug-induced depression of consciousness during which:

1. a person responds purposefully to verbal commands, either alone or when accompanied by light tactile stimulation;

2. intervention is not required to maintain a person's airway, and spontaneous ventilation is adequate; and

3. a person's cardiovascular function is usually maintained.

Minimal Sedation

The act defines “minimal sedation” as a minimally depressed level of consciousness that:

1. is produced by a pharmacological method that retains a person's ability to independently and continuously maintain an airway and to respond appropriately to physical stimulation or a verbal command,

2. may result in modest impairment of cognitive function and coordination but does not affect a person's ventilator and cardiovascular function, and

3. is produced by nitrous oxide or an orally administered sedative (a) using no more than the maximum therapeutic dose recommended by the federal Food and Drug Administration and (b) that may be prescribed to a person for unmonitored use at home.

OLR Tracking: ND; JKL; PF; BS