nitrous oxide inhalation analgesia - Minnesota Board of Dentistry

D. Enteral & Parenteral Sedation Facility, and Equipment – RecommendationsThe following equipment is RECOMMENDED for the emergency kit/cart for Sedation/anesthesiaemergency management. The equipment should be readily accessible and should be used in a manner thatis consistent with the practitioner’s level of training and skill. The equipment must be age and weightappropriate for pediatric and adult patients. There must be a routine equipment maintenance record keptby the dentist to ensure that the equipment is kept in working order. Please attach a separate sheet (ifneeded) with rationale for absent or substituted medications.*Applicant must initial each of the following to indicate compliance.*____________Recommendations for Enteral Moderate Sedationblood pressure sphygmomanometer/cuffs ofappropriate sizes with stethoscope orautomatic blood pressure monitorECG monitoring device (may be combinedwith pulse oximetry device)IM equipment:___ gauze sponges___ needles of various sizes___ syringes___ sterile glovesseveral types/sizes of resuscitation masksRecommendations for Parenteral Moderate Sedation__________________blood pressure sphygmomanometer/cuffs ofappropriate sizes with stethoscope orautomatic blood pressure monitorECG monitoring device (may be combinedwith pulse oximetry device)IV and IM equipment:___ IV fluids, tubing and infusion sets___ tape___ sterile water___ gauze sponges___ needles of various sizes___ syringes___ tourniquet___ sterile glovesseveral types/sizes of resuscitation masksMagill forcepsadvanced airway management equipment (e.g.,LMA, Combi Tube, King Airway, etc.Additional Items to be Evaluated for both Enteral and Parenteral:___supplemental gas delivery system & back-upsystem___equipment age and weight appropriate forpediatric and/or adult patients____________patient transportation protocol in placesterilization area____ designated sterile area____ sterilization manual and protocol____ designated non-sterile areapreparation of sedation medication____ appropriate storage for medication____ appropriate mode/method of administrationequipment readily accessible - consistent withlicensee’s level of training and skill______treatment room/s___ treatment room permits the team (consistingof at least two individuals) to move freelyabout the patient___ chair utilized for treatment permits patient tobe positioned so the team can maintain theairway___ treatment chair permits the team to alterpatient’s position quickly in an emergency___ treatment chair provides a firm platform forthe management of CPR___ adequate equipment for establishment of anintravenous infusionlicensee has emergency protocol manualList any deficiencies:4