Deep Sedation Standards

The College is updating its
documents to reflect the

transition to regulation under
the Health Professions Act and
College Bylaws. The principles
and requirements outlined in all
documents continue to apply to
dentists and CDAs.
DEEP SEDATION SERVICES

IN DENTISTRY
(NON-HOSPITAL FACILITIES)
This document contains standards of practice in relation to inducing deep sedation while
providing dental services in British Columbia. Since contravention of these practice
standards may be considered unprofessional conduct, dentists employing any modality
of deep sedation must be familiar with the content of this document, be appropriately
trained, and govern their professional practices accordingly.
These practice standards are minimum requirements and the CDSBC does not represent
that they are sufficient or adequate in any particular situation. Dentists must exercise
their own professional judgment in determining what practices and procedures they will
employ in order to ensure patient safety and to minimize the risk of patient complaints
or claims.
Please note: As of September 2019 a new essential drugs list has been placed in
these standards and guidelines. Please see page 2-12 for the updated
information. The rest of this document will be updated in the coming months.
College of Dental Surgeons of BC

110 - 1765 West 8th Avenue
Vancouver, BC V6J 5C6
Phone (604) 736-3621
Copyright © 2008. All rights reserved
Updated: August 2008 (essential drugs list added September 2019)
Regulating dentistry in the public interest

TABLE OF CONTENTS
CHAPTER 1
INTRODUCTION .................................................................................................. 1-1
I. OVERVIEW ............................................................................................................ 1-1
II. DEFINITIONS ........................................................................................................ 1-1
CHAPTER 2
STANDARDS FOR DEEP SEDATION ...................................................................... 2-1
I. DEEP SEDATION TEAM .......................................................................................... 2-1
A. PRACTITIONER ADMINISTERING DEEP SEDATION .................................................................... 2-1
1. Qualifications ................................................................................................................... 2-
1
2. Approval of Qualifications .................................................................................................. 2-
1
3. Responsibilities ................................................................................................................ 2-
2
B. OPERATING DENTIST ............................................................................................................ 2-2
C. DEEP SEDATION ASSISTANT .................................................................................................. 2-2
D. OPERATIVE ASSISTANT ......................................................................................................... 3-2
E. RECOVERY SUPERVISOR ....................................................................................................... 2-3
II. PHYSICAL FACILITIES ........................................................................................... 2-3

A. LAYOUT AND DESIGN............................................................................................................ 2-3
1. Space Requirements ......................................................................................................... 2-

4
2. Operating Room and Recovery Area .................................................................................... 2-
4
B. UTILITIES / BACKUP SYSTEMS ............................................................................................... 2-4
1. Electrical Supply / Lighting ................................................................................................. 2-

4 2. Suction ............................................................................................................................
2-4
III.FACILITY OPERATING REQUIREMENTS .................................................................. 2-5
A. INFECTION CONTROL ............................................................................................................ 2-5
B. DRUG CONTROL ................................................................................................................... 2-5
C. SAFETY REQUIREMENTS ........................................................................................................ 2-5
D. MEDICAL EMERGENCY PROCEDURES ....................................................................................... 2-5
IV. DEEP SEDATION ARMAMENTARIUM ....................................................................... 2-6
CDSBC DEEP SEDATION SERVICES IN DENTISTRY

A. GENERAL CONSIDERATIONS .................................................................................................. 2-6
1. Equipment Standards ........................................................................................................ 2-

6
2. Servicing, Maintenance and Inspections ............................................................................... 2-
6
B. DEEP SEDATION DELIVERY SYSTEM ........................................................................................ 2-7
C. PHYSIOLOGICAL MONITORING EQUIPMENT ............................................................................. 2-7
D. ESSENTIAL AIRWAY EQUIPMENT ............................................................................................ 2-8
1. Bag and Mask Management ................................................................................................ 2-

8
2. Suction Apparatus .............................................................................................................
2-8
3. Intubation ........................................................................................................................
2-8
E. DEEP SEDATION DRUGS AND SUPPLIES .................................................................................. 2-9
1. Sedative Drugs ................................................................................................................. 2-

9
2. Venipuncture ....................................................................................................................
2-9
3. Other Supplies ................................................................................................................. 2-
9
F. EMERGENCY ARMAMENTARIUM .............................................................................................. 2-9
1. Emergency Equipment ..................................................................................................... 2-

10 2. Emergency Drugs ........................................................................................................... 2-10 V.
DEEP SEDATION PROCEDURE ............................................................................... 2-11
ii CDSBC
A. PRE-SEDATION EVALUATION ............................................................................................... 2-11
B. INFORMED CONSENT .......................................................................................................... 2-12
C. PRE-SEDATION INSTRUCTIONS ............................................................................................ 2-13
D. ADMINISTRATION OF DEEP SEDATION .................................................................................. 2-13
E. MONITORING ..................................................................................................................... 2-14
F. RECOVERY AND DISCHARGE ................................................................................................ 2-14
G. POST-SEDATION INSTRUCTIONS .......................................................................................... 2-15
VI. SEDATION RECORDS ............................................................................................ 2-15

A. PRE-SEDATION RECORD ...................................................................................................... 2-15
1. Vital Statistics ................................................................................................................ 2-

15
2. Medical History Questionnaire ........................................................................................... 2-
16
3. Physical Examination ....................................................................................................... 2-
16
B. DEEP SEDATION RECORD .................................................................................................... 2-17
C. RESUSCITATION RECORD .................................................................................................... 2-17
D. INCIDENT REPORT .............................................................................................................. 2-18

CHAPTER 3
AUTHORIZATION FOR NON-HOSPITAL DEEP SEDATION FACILITIES ................... 3-
1
I. INTRODUCTION .................................................................................................... 3-1
II. AUTHORIZATION CLASSIFICATIONS ..................................................................... 3-1
A. FULL AUTHORIZATION .......................................................................................................... 3-1
B. PROVISIONAL AUTHORIZATION ............................................................................................. 3-1
C. UNACCEPTABLE FOR AUTHORIZATION .................................................................................... 3-2
III. SURVEY TEAM ...................................................................................................... 3-2

A. MEMBERSHIP ....................................................................................................................... 3-2
B. SELECTION OF SURVEY TEAM – OPPORTUNITY/OBLIGATION TO RAISE CONCERNS ..................... 3-2
C. CONFIDENTIALITY ................................................................................................................ 3-2
IV. SURVEY FOR AUTHORIZATION OF FACILITY .......................................................... 3-3

A. APPLICATION ....................................................................................................................... 3-3
1 Initial Application ............................................................................................................... 3-

3
2. Renewal Application .......................................................................................................... 3-
3
3. Qualifications of Facility Staff ............................................................................................. 3-
3
B. SURVEY SCHEDULING ........................................................................................................... 3-3
C. FEES FOR SURVEY ................................................................................................................ 3-3
D. SITE VISIT .......................................................................................................................... 3-3
E. SURVEY REPORT .................................................................................................................. 3-4
F. FOLLOW-UP ......................................................................................................................... 3-5
G. ANNUAL FACILITY SELF-ASSESSMENT AND STATUS CONFIRMATION .......................................... 3-5
H. SALE OF FACILITY ................................................................................................................ 3-4
CHAPTER 4
CDSBC iii
SAMPLE FORMS ................................................................................................... 4-1
PRE-SEDATION RECORD ................................................................................................. 4-2
PRE-SEDATION RECORD PHYSICIAN’S ASSESSMENT .......................................................... 2-4
PATIENT'S CONSENT TO DENTAL TREATMENT AND DEEP SEDATION ..................................... 4-
5 PRE-SEDATION PATIENT INSTRUCTIONS .......................................................................... 4-
6 POST-SEDATION PATIENT INSTRUCTIONS ........................................................................ 4-
7 DEEP SEDATION RECORD ............................................................................................... 4-
8 RESUSCITATION RECORD ...............................................................................................
4-9
INCIDENT REPORT ........................................................................................................ 4-10

PRE-SEDATION CHECKLIST............................................................................................ 4-11
EQUIPMENT SPECIFICATIONS ........................................................................................ 4-12

APPENDICES
CSA CONTACT INFORMATION ................................................................. Appendix I
INSPECTION OF MEDICAL DEVICES ........................................................ Appendix II
ANNUAL FACILITY SELF ASSESSMENT AND STATUS CONFIRMATION .......... Appendix III

CHAPTER 1
INTRODUCTION
I. OVERVIEW
Deep sedation procedures in dentistry allow patients to have dental

treatment with minimal physiological and psychological stress, and enhanced
physical comfort.
The College of Dental Surgeons of British Columbia (the “CDSBC”) has

developed these Practice Standards which are designed to apply to all
practitioners providing deep sedation services. The Practice Standards are
intended to provide a framework for a reasonable standard of patient care,
and should be interpreted in that light, allowing for some degree of flexibility
in different circumstances.
It is recognized that there is a continuum of sedation, and, as a patient

moves along the continuum from deep sedation to moderate sedation, the
importance of having a deep sedation assistant present is diminished (see
Chapter 2 for Deep Sedation Team requirements). Once a patient has clearly
moved into a state of moderate sedation, it may not be necessary for the
deep sedation assistant to be present. The practitioner administering the
deep sedation must make a professional judgment to determine when a
patient has moved into a state of moderate sedation.
Deep sedation facilities must not operate without an authorization from the
CDSBC or the College of Physicians and Surgeons of British Columbia (the
“CPSBC”). While these Practice Standards are concerned primarily with deep
sedation services in dental offices, dentists must satisfy themselves that the
equipment and procedures used in any location in which they operate
conform to these standards.
Note: Any technique that depresses the patient beyond deep sedation is
considered to be general anaesthesia, in which case the Practice Standards in
the CDSBC General Anaesthetic Services in Dentistry (Non-Hospital Facilities)
apply.
II. DEFINITIONS
In this document, the following definitions apply:
ACLS: Advanced Cardiac Life Support
BLS: Basic Life Support (CPR Level C)
CSA: Canadian Standards Association.
CDSBC DEEP SEDATION SERVICES IN DENTISTRY 2- 1

CDSBC: The College of Dental Surgeons of British Columbia.
CPSBC: The College of Physicians and Surgeons of British Columbia.
Committee: Sedation and General Anaesthetic Services Committee
Council: The governing body of the College of Dental Surgeons of British

Columbia.
Deep sedation: A controlled state of depressed consciousness accompanied by

partial loss of protective reflexes including the inability to respond purposefully to
verbal command, produced by a pharmacologic or non-pharmacologic method or a
combination thereof.
General anaesthesia: A controlled state of unconsciousness accompanied by loss

of protective reflexes, including an inability to maintain an airway independently
and to respond purposefully to physical stimulation or verbal command. This state
therefore applies to any technique which has depressed the patient beyond deep
sedation.
Moderate sedation: A depression of consciousness during which patients respond

purposefully to verbal command, either alone or when accompanied by light tactile
stimulation. No interventions are required to maintain a patent airway, and
spontaneous ventilation is adequate. Cardiovascular function is usually maintained.
Usually associated with multiple oral drugs combined with or without nitrous
oxide/oxygen, or parenteral sedation.
Standards: The practice standards described in this document.
Operating dentist: A licensed member of the College of Dental Surgeons of

British Columbia.
OMAAP: Oral and Maxillofacial Surgeons Anaesthesia Assistant Program.
Registrar: The Registrar of the College of Dental Surgeons of British Columbia.
Sedation/General Anaesthesia Register: A College of Dental Surgeons Register

of dentists providing sedation and/or general anaesthesia services.
Category I: Moderate sedation

Category II: Deep sedation
Category III: General Anaesthesia
Standards: The practice standards described in this document.
2-2 DEEP SEDATION SERVICES IN DENTISTRY CDSBC

CHAPTER 2
STANDARDS FOR DEEP SEDATION
I. DEEP SEDATION TEAM
In circumstances where the operating dentist is simultaneously providing

deep sedation services with other dental procedures, the deep sedation team
must consist of the following individuals: operating dentist, deep sedation
assistant, operative assistant, recovery supervisor, and office assistant.
Where there is a qualified person other than the operating dentist (see item
A.1 below) administering the deep sedation, the deep sedation assistant is
not usually required.
Dentists, physicians and other personnel on the deep sedation team should
be instructed in and be familiar with proper deep sedation protocol, and their
responsibilities should be outlined in current job descriptions. All clinical staff
must be trained in BLS (CPR Level C), and their duties in an emergency must
be well defined.
A. PRACTITIONER ADMINISTERING DEEP SEDATION
1. Qualifications
Deep sedation services must only be administered by dentists or
physicians who are currently licensed to practise in British
Columbia with their respective College and who possess the
following additional qualifications:
• Dentists who have successfully completed a postgraduate

program in anaesthesia in a university and/or teaching
hospital, for at least 12 consecutive months, with the
program specifically evaluating and attesting to the
competency of the individual. Evidence of successful
completion of a provider course in Advanced Cardiac Life
Support (ACLS) is also required.
• Dentists who have successfully completed a postgraduate

program in oral and maxillofacial surgery suitable for
specialty certification in British Columbia, incorporating
adequate training in anaesthesia and ACLS, with the
program specifically evaluating and attesting to the
competency of the individual in these areas.
• Dentists who have not completed training in ACLS as part of

a postgraduate program are required to successfully
complete a course in ACLS approved by the College.

• Physicians currently approved by the CPSBC to provide
general anaesthesia.
2. Approval of Qualifications
Dentists must submit to the CDSBC credentials that confirm the
foregoing qualifications and must be approved by the CDSBC
before administering any deep sedation services.
3. Responsibilities
A practitioner or operating dentist must not provide deep
sedation services or perform dental services on a patient who is
under deep sedation unless the operating dentist is satisfied
that these Practice Standards will be met.
Practitioners administering deep sedation must possess the

knowledge and technical skills necessary to perform such
services to required standards, including the ability to:
• Provide pre-sedation evaluation of the patient and
determine appropriate management
• Administer the deep sedation
• Monitor and support the vital organ systems during the
sedation period
• Provide immediate post-sedation management of the
patient
• Provide resuscitation or emergency care, if necessary
In addition to clinical responsibilities, practitioners administering

deep sedation must also ensure the following are in place:
• policies and procedures concerning the safe
administration of deep sedation, including education,
training and supervision of personnel
• procedures for maintenance of necessary records for the
evaluation of all deep sedation services provided in the
facility
B. OPERATING DENTIST
The dentist providing services under deep sedation must be currently

licensed to practise by the CDSBC and must be familiar with the
modality being used for pain and anxiety control, including indications,
contraindications, patient evaluation, patient selection, pharmacology
of relevant drugs, and management of potential adverse reactions.
The dentist must also hold a current BLS (CPR Level C) certificate.
C. DEEP SEDATION ASSISTANT
The deep sedation assistant must be a nurse currently registered with

the British Columbia College of Nursing Professionals, a person who
has successfully completed a respiratory therapy program, a dentist

currently licensed to practise by the CDSBC, a physician currently
licensed to practise by the CPSBC, a person who has successfully
completed DAANCE/OMAAP (Please note that dentists may only
delegate to a certified dental assistant duties that are listed in the
restricted activities provided in CDSBC Bylaw Part 8, 8.05 and 8.06) or
a person who has completed a comparable program approved by the
Board. Responsibilities include assessing and maintaining a patent
airway, monitoring vital signs, recording appropriate findings and
assisting in emergency procedures. Registered nurses, physicians, and
qualified dentists’ duties may also include venipuncture and
administering medications as required. The deep sedation assistant
must hold a current BLS or CPR-HCP equivalent certificate.
Note: The roles of the deep sedation assistant and the operative
assistant are independent of each other and cannot be combined. Two
individuals are required to discharge the respective responsibilities of
these positions.
D. OPERATIVE ASSISTANT
The operative assistant must be appropriately trained and must hold a

current BLS (CPR Level C) certificate.
E. RECOVERY SUPERVISOR
II. The recovery supervisor's primary duties and responsibilities are supervising
and monitoring patients in the recovery area. The recovery supervisor must
be a nurse registered with the British Columbia College of Nursing
Professionals, a dentist currently licensed to practise by CDSBC, a physician
currently licensed to practise by the CPSBC, a person who has successfully
completed DAANCE/OMAAP, or a person who has completed a comparable
program approved by the Board. Responsibilities include assessing and
maintaining a patent airway, monitoring vital signs, recording appropriate
findings, and assisting in emergency procedures. Registered nurses,
physicians, and qualified dentists’ duties may also include venipuncture and
administering medications as required. The recovery supervisor must have
adequate training in post-sedation recovery and must hold a current BLS or
CPR-HCP equivalent certificate.
III. PHYSICAL FACILITIES
The facility must comply with all applicable federal, provincial and municipal
laws, including building and fire codes. Emergency ambulance and treatment
service must also be available in the community. The facility must be
authorized by the CDSBC (see Chapter 3), or by the CPSBC.

A. LAYOUT AND DESIGN
The general physical design for a deep sedation facility depends on the
number and types of dental and surgical procedures to be performed.
Traffic flow for patients and staff should be convenient and must
permit ready transfer of emergency cases to an acute care facility.
Doorways must be wide enough to allow wheelchair, stretcher, and
chaircot access.
1. Space Requirements
Functions needing adequate space are:

• Reception and waiting
• Administrative activities for patient interview, patient
admission, business functions, record storage
• Pre-operative evaluation and preparation for deep
sedation
• Operative/surgical treatment
• Post-sedation recovery
• Preparation and sterilization of instruments
• Storage for equipment, gases, drugs and supplies
• Staff activities
2. Operating Room and Recovery Area
The operating room and the post-sedation recovery area, if

separate from the operating room, must provide a safe
environment. Requirements include the following:
• Areas must be large enough to accommodate all required

equipment and staff.
• Dental chairs and tables used for deep sedation and recovery
must be adequately padded and adjustable (capable of being
placed in supine and head down positions).
• Electrically operated equipment must meet applicable CSA
standards.
B. UTILITIES/BACKUP SYSTEMS
1. Electrical Supply/Lighting
• Electrical outlets must be accessible and adequate to

accommodate all necessary equipment.
• Room lighting must be adequate to permit evaluation of the
patient's skin and mucosal color.
2. Suction

Bedside suction must be available for every patient in both
the operating room and recovery areas.
Because of the possibility of a power failure, central medical gas

system failure, or equipment malfunction, appropriate backup must be
available to provide light, suction, and oxygen.
III. FACILITY OPERATING REQUIREMENTS
A. INFECTION CONTROL
Sterilization facilities must conform to currently accepted standards of

practice in the area of infection control, and, at a minimum, all
sedation equipment which comes into direct contact with patients must
be cleaned, disinfected, and sterilized before use. Procedures for safe
disposal of clinical materials must also be in place.
B. DRUG CONTROL
• Appropriate storage must be available for clinical materials and

drugs (e.g., refrigeration where required).
• All drugs and agents must be correctly identified and not out-dated.
• All supplies of narcotics must be appropriately recorded and stored

in a separate, locked cabinet.
C. SAFETY REQUIREMENTS
All applicable laws and regulations pertaining to the safe

operation of a deep sedation facility must be complied with, including
all applicable laws and regulations pertaining to:
• the preparation, storage, identification and use of medical gases,

sedative drugs and related materials;
• hazards from fires, explosions, electrical facilities, electrocution,
earthquake, and other natural hazards; and
• the safe and effective operation of all equipment used in the
facility.
D. MEDICAL EMERGENCY PROCEDURES
The deep sedation team must be prepared to recognize and treat

adverse responses, utilizing appropriate equipment and drugs when
necessary, and must be capable of initiating definitive treatment for
medical emergencies. All members of the deep sedation team must

have the training and ability to perform basic cardiac life support
techniques.
Protocols for emergency procedures, including arrangements for

hospital transfer, must be established and reviewed on a regular basis.
Emergency numbers must be posted by the telephones in the facility,
and the duties of all staff (practitioner administering the deep
sedation, operating dentist, deep sedation assistant, operative
assistant, recovery supervisor, receptionist, etc.) should be specified in
writing.
IV. DEEP SEDATION ARMAMENTARIUM
All necessary equipment, drugs and supplies comprising the deep sedation
armamentarium must be readily available and in proper working order,
including emergency equipment for resuscitation and life support.
The practitioner administering the deep sedation must be familiar with these
Practice Standards, and the facility’s current list of deep sedation equipment,
corresponding log books indicating maintenance and servicing, and list of
drugs available with their expiry dates noted.
A. GENERAL CONSIDERATIONS
1. Equipment Standards
Medical gas piping systems, physiological monitoring equipment,

and related medical devices must meet current CSA standards
unless the Committee is satisfied that compliance with those
standards is not necessary. (Refer to Appendix I: CSA Contact
Information.) In addition, the specific requirements of
provincial legislation must be adhered to.
2. Servicing, Maintenance and Inspections
Medical gas piping systems, monitoring equipment and related

medical devices must receive the care and maintenance
recommended by the manufacturer. Equipment must be
serviced by qualified personnel in accordance with the
manufacturer’s specifications, or annually, whichever is more
frequent. Details of such servicing and maintenance must be
recorded in an appropriate logbook, which must be available on
the premises for the review of the practitioner(s) using the
equipment.
All medical devices (including anaesthetic machines and

accessories, monitors, pulse oximeters, oxygen analyzers,
temperature probes, defibrillators, etc.) must only be serviced
by a registered biomedical engineer or a biomedical technologist

having expertise in deep sedation and general anaesthetic
medical device technology and related standards. All medical
devices must be inspected by a registered biomedical engineer
or a biomedical technologist, as described above, at the greater
of the following frequencies:
• As recommended by the manufacturer.

• Every six months for anaesthetic machines.
• Every twelve months for all other medical devices.
In addition, defibrillators must be inspected and discharged

bimonthly by appropriately trained personnel, and details of
these inspections must be recorded in a logbook maintained by
the owner of the facility. (Refer to Appendix II: Inspection of
Medical Devices.)
Note: If a visiting dentist or physician brings his/her own

monitoring equipment to an authorized deep sedation facility, it
must also be serviced, maintained and inspected as required by
these Practice Standards, and appropriate records must also be
maintained.
B. DEEP SEDATION DELIVERY SYSTEM

Components of the deep sedation delivery system may include sources
of compressed oxygen and anaesthetic gases, reducing valves,
flowmeters, vaporizers, carbon dioxide absorption systems, inspiratory
and expiratory valves, escape valves, reservoir bags, breathing tubes,
and face masks.
1. Machines used for the delivery of medical gases are numerous in
terms of type, style and manufacturer. Regardless of which
specific machine is used, it must function reliably and accurately
with respect to gas pressure and concentrations, and must
comply with all standards described in item IV.A above.
2. The installation of gas piping or conducting systems must be
performed by competent and experienced personnel, and must
comply with all standards dictated by the manufacturer and
applicable regulatory bodies.
3. Appropriate safety indexing systems for all medical gas
connections must be in place to eliminate the possibility of
connecting the wrong medical gas in the system.
4. Before each case, adequacy of the volumes of gases on hand
should be confirmed, along with the availability of a backup
supply of oxygen to ensure that the supply of oxygen cannot fail
during treatment. The reserve supply of oxygen should be a
portable cylinder (minimum “E” size), ready for immediate use
with appropriate regulator, flowmeter and connectors attached.
5. Gases must be stored and properly locked so that they are
inaccessible to third parties.

6. A satisfactory scavenging system for removing waste
anaesthetic gases from the office environment must be installed
according to the manufacturer’s specifications and tested
periodically as required in British Columbia hospitals. (Refer to
Regulations made under the Workers Compensation Act.)
C. PHYSIOLOGICAL MONITORING EQUIPMENT

The non-hospital deep sedation facility owner is responsible for the
provision and maintenance of physiological monitoring equipment that
meets original performance specifications and standards as described
in item IV.A above. These devices are not a substitute for constant
personal contact with the patient, and must not replace sound clinical
judgment and observation of each individual case.
The following must be available for each sedated patient:
1. Stethoscope (either precordial, esophageal or paratracheal).
2. System for monitoring blood pressure with appropriately sized
cuffs.
3. ECG monitor with continuous audible signal recognition.
4. System for monitoring temperature (if triggering agents for
malignant hyperthermia are used).
5. Pulse oximeter.
6. If secondary/tertiary gases are used, oxygen gas analyzer with
alarm or fail-safe mechanism for cut-off of non-oxygen gases.
In addition, at least one functional battery-powered pulse oximeter

must be available.
D. ESSENTIAL AIRWAY EQUIPMENT
The facility must be equipped to enable comprehensive management

of the airway, electively or in response to an emergency.
1. Bag and Mask Management
- Oral and nasopharyngeal airways appropriate for patient's

size.
- Ventilation apparatus with adapter to fit tracheal tube.
- Facemasks appropriate for patient's size that can be used
with ventilation apparatus.
- Oxygen source that can be used with ventilation apparatus.
2. Suction Apparatus
The following equipment must be present, adapted to the vacuum

system and compatible with a functional back-up vacuum system:
- Tonsil suction.
2 - 10 DEEP SEDATION SERVICES IN DENTISTRY CDSBC

- Catheters for cleaning the pharynx, larynx, trachea, and
bronchi.
- Nasogastric tubes.
3. Intubation
The following intubation equipment must be present:
- Laryngoscope with preferred blades.

- Extra laryngoscope.
- Blades of different sizes and types (curved and straight).
- Spare batteries and bulbs.
- Endotracheal tubes of appropriate sizes, cuffed and
noncuffed.
- Syringe for inflating cuff.
- Lubricants.
- Stylettes that will fit tracheal tube.
- Forceps (Magill).
- Emergency airway adjuncts (difficult intubation kit), which
must include tracheotomy or cricothyrotomy sets.
(Note: At the discretion of the practitioner administering the
deep sedation, the intubation equipment may include
laryngeal mask and lighted sylette.)
E. DEEP SEDATION DRUGS AND SUPPLIES
1. Sedative Drugs
The choice of sedative drugs must be determined by the

practitioner administering the deep sedation, who must ensure
that all drugs are current and stored appropriately.
The prescribing and dispensing of drugs should comply with

CDSBC Policy on that subject.
2. Venipuncture
Intravenous equipment and supplies must include the following:
- Cannulas (needles).
- Catheters.
- Administration sets (adult/pediatric/mini-drip).
- Intravenous stand.
- Intravenous solutions (choice to be determined by
practitioner administering the deep sedation).
3. Other Supplies

Accessory equipment and supplies such as the following must be
available and stored appropriately:
- Needles (various types/sizes).

- Syringes (various sizes).
- ECG leads and electrodes.
- Defibrillation paste or pads.
- Sponges, tape, etc.
- Throat packs.
- Lubricants.
- Disposal container for sharps.
- Padding (e.g., pillow) to help in head positioning.
F. EMERGENCY ARMAMENTARIUM
Emergency equipment and drugs must be consolidated and stored in a

well-organized, self-contained, mobile unit (cart or kit) at a centralized
location that is readily available at all times. Drugs must be current and
readily identifiable. The emergency cart or kit will contain all drugs and
equipment necessary to perform emergency procedures. An emergency cart
or kit must be present in each facility before any procedure is commenced.
Emergency carts or kits must not be shared with other facilities when
sedations are performed. The emergency cart or kit must be present until the
patient is discharged from the facility.
1. Emergency Equipment
a. Airway Adjuncts (see item D, Essential Airway Equipment)

b. Intravenous Equipment (see item E2, Venipuncture)
c. Defibrillator
Each facility must have a defibrillator that conforms to CSA

standards. It must be tested bi-monthly by appropriately
trained personnel, and, as previously noted, records of testing
and maintenance must be kept in an appropriate logbook.
Note: The equipment required for long-term cardiac life support

is not essential in an out-patient deep sedation facility, because
there is a low likelihood of it being used, and also because
attempts to initiate its use would likely delay hospital transfer.
2. Emergency Drugs
A. Essential Emergency Drugs

There must be a minimum of two ampoules, except as noted, of
the following essential emergency drugs:
- Adenosine

Antiarrhythmic
- Atropine
- Benadryl
- Dantrolene sodium (8 - 12 ampoules, enough for 2 mg/kg
dose), if a triggering agent is used
- Epinephrine
- Flumazenil, if benzodiazepines are being used
- Hydrocortisone or Solumedrol
- Lidocaine
- Naloxone, if narcotics are being used
- Nitroglycerine
- Succinycholine
- Ventolin
B. Highly Recommended Emergency Drugs

It is highly recommended that the following emergency drugs
also be kept on hand:
Amiodarone
Digoxin
Ephedrine
Furosemide
Hydralazine
Isoproterenol
Labetalol hydrochloride
Morphine
Phenylephrine
Procainamide
Propranolol
Sodium bicarbonate 50 meq
Verapamil
* Not required if triggering agents are used only for emergencies

V. DEEP SEDATION PROCEDURE
A. PRE-SEDATION EVALUATION
1. Since deep sedation procedures are potentially life threatening, patients
about to undergo deep sedation in a non-hospital facility should
normally conform to American Society of Anaesthesiology (ASA) physical
status Class I (normal healthy patient) or Class II (patient with mild
systemic disease). However, Class III patients (patients with severe
systemic disease that limits activity but is not incapacitating) may be
accepted for treatment if the patient’s disease is not expected to be
affected by the sedation. Patients not conforming to these
classifications should be referred to a hospital for deep sedation, or
consideration should be given to a more appropriate sedation technique.
In any surgical procedure where post-operative care and observation
are expected to be lengthy, the patient should be hospitalized.

AMERICAN SOCIETY OF ANAESTHESIOLOGY PHYSICAL STATUS CLASSIFICATION SYSTEM
ASA I: A normal healthy patient.

ASA II: A patient with mild systemic disease.
ASA III: A patient with severe systemic disease that limits activity but is not
incapacitating.
ASA IV: A patient with incapacitating systemic disease that is a constant threat to life.
ASA V: A moribund patient not expected to survive 24 hours with or without operation.
ASA E: Emergency operation of any variety; E precedes the number indicating the patient’s
physical status.
2. The pre-sedation evaluation must be conducted by the

practitioner who will be providing the deep sedation services to
the patient, or by the patient's physician in consultation with the
practitioner administering the deep sedation. At the time of the
pre-sedation visit, the practitioner should take a medical history
and perform an appropriate physical examination to facilitate
plans for the administration of deep sedation. The history
should include inquiries regarding previous drug therapy,
unusual reactions or responses to drugs, and previous deep
sedation/anaesthetic experiences, including problems and
complications. Information about deep sedation which a
reasonable person would consider relevant, including the risks
and nature of complications which may occur, should be
discussed and confirmed in writing. Details of the pre-sedation
assessment must also be documented on the patient's chart.
3. Where indicated, pertinent medical consultations and laboratory

tests must be obtained and the results reviewed pre-operatively.
The requirement for tests is determined by the practitioner
administering the deep sedation based on the patient's medical
history.
4. The time interval between the pre-sedation evaluation and the

deep sedation procedure should not exceed 90 days. If that
time period is exceeded, a further pre-sedation evaluation
should be considered. The practitioner administering the deep
sedation should confirm, immediately before commencing the
administration of deep sedation, that there have been no
changes in the patient’s medical condition since the original
deep sedation evaluation which would affect the safe provision
of deep sedation services.
5. The operating dentist and the patient's physician have a

responsibility to inform the practitioner administering the deep
sedation of problems known to them which may affect the safe

administration of deep sedation. The practitioner administering
the deep sedation must be aware of the planned dental
procedures, duration of the procedures, potential blood loss,
number of appointments anticipated, and any drugs the
operating dentist intends to use (including their routes of
administration) pre-operatively, during the treatment, and
postoperatively. It is the responsibility of the practitioner
administering the deep sedation to determine whether or not
the clinical information and laboratory test results are adequate,
if further consultation is required, and, in the final analysis,
whether it is safe for the patient to undergo deep sedation.
6. Any difference of opinion between the operating dentist and the

practitioner administering the deep sedation with regard to the
care of the patient must be resolved before the operation.
B. INFORMED CONSENT
Any intentional touching of a person without the person's consent may

constitute a battery.
It is therefore very important that written informed consent be

obtained during the pre-operative visit and before any sedative is
administered. Consent to a particular dental treatment does not
necessarily imply consent to the use of deep sedation. It is highly
recommended that a specific consent for each be obtained in writing.
Except in an emergency, the patient must be given an appropriate

nontechnical explanation of the planned treatment, associated hazards
or complications, and chances of success or failure. The patient should
also be advised on alternatives to the planned dental and deep
sedation procedures, including the alternative of not undergoing
treatment, and the possible consequences of those alternatives. It is
highly recommended that this not only be documented in the patient’s
records but also confirmed to the patient in writing. Whenever
possible, the patient must be given a choice of treatment alternatives.
If the patient is either a minor who does not meet the consent criteria
in Section 17 of the Infants Act (as it may be amended from time to
time), or is an adult who is incapable of giving or refusing consent to
the proposed treatment, the informed consent must be obtained from
the minor’s parent or from the minor’s or incompetent adult’s legally
authorized representative.
Dentists should seek specific legal advice if they are unsure or have
any difficulty in determining who, in a particular situation, qualifies as
the minor’s or incompetent adult’s legally authorized representative, or
whether the patient is competent to provide an informed consent.

Note: The pre-sedation and post-sedation responsibilities of the
patient are an important aspect of treatment, and it is highly
recommended that written acknowledgment of these be obtained at
the same time as the informed consent.
C. PRE-SEDATION INSTRUCTIONS
The patient must be adequately instructed in preparation for deep

sedation and should be provided with a pre-sedation instruction sheet.
A standard policy should be followed concerning the minimum time
interval from last oral intake to the induction of deep sedation (e.g.,
minimum of three hours after clear fluids and minimum of six hours
after solid food is recommended). Possible exceptions to this policy
would include usual medications or pre-operative medications, which
may be taken as deemed necessary by the dentist. Medication to be
taken by a patient before deep sedation should be ordered by the
practitioner administering the deep sedation, or by the dentist
providing treatment, in consultation with the practitioner administering
the deep sedation. Dosage, time and route of administration must be
specified.
D. ADMINISTRATION OF DEEP SEDATION
1. Immediately before the administration of deep sedation, the

presence and serviceability of equipment should be confirmed
using a standardized checklist to prevent any oversights or
omissions.
2. The practitioner administering the deep sedation must ensure

that a continuous intravenous access is established and
maintained throughout the procedure. An intermittent or
continuous fluid administration must be used to ensure patency.
3. It is recommended that the duration of a deep sedation

procedure in a non-hospital facility be no longer than three and
one half-
hours per session, as sedations of longer duration have a
significantly higher incidence of complications and prolonged
recovery times.
4. In a non-hospital deep sedation facility, the practitioner

administering the deep sedation is primarily responsible for the
patient and must remain with the patient at all times during the
deep sedation, including the recovery period, unless the
recovery area is constantly staffed by a recovery supervisor with
training in post-sedation recovery. The practitioner
administering the deep sedation must determine the appropriate

time to transfer the patient to the recovery area and must
provide direction for the patient’s release from the facility.
5. The dentist should recognize that the sedation of children

represents a unique clinical challenge. The child’s age and
weight must be considered and dosages adjusted accordingly to
ensure that the intended level of sedation is not exceeded.
The practice of simultaneous or overlapping administration of deep

sedation by one dentist or physician for concurrent dental procedures
on two or more patients is unsafe and therefore impermissible.
E. MONITORING
The practitioner administering the deep sedation is responsible for

monitoring the patient. This includes making sure that appropriate
monitoring equipment is available and properly maintained, and that
policies for monitoring requirements are established to help ensure
patient safety.
Clinical observation must be supplemented by the following means of

physiological monitoring, usually performed every five minutes,
throughout the deep sedation administration:
1. Continuous pulse oximetry.

2. System to monitor blood pressure.
3. Continuous electrocardioscope monitoring, at the discretion of
the practitioner administering the deep sedation.
4. If using an anaesthetic machine, oxygen gas analyzer with
alarm.
Monitoring equipment should be equipped with appropriate alarms to

signal malfunctions or any other threats to patient safety.
F. RECOVERY AND DISCHARGE
The patient should remain in the dental chair and not be moved to the
recovery area until he/she has regained protective reflexes. Earlier
transfer may only be considered if the recovery area is appropriately
equipped and constantly staffed by a trained recovery supervisor who
can supervise and monitor the patient. The practitioner administering
the deep sedation should discuss the care of the patient with the
recovery room staff, identifying any special problems related to the

patient's safe recovery from the sedated state. Pulse oximetry must
be available.
Recovery status post-operatively and readiness for discharge must be

specifically assessed and recorded by the practitioner administering
the deep sedation or by the recovery supervisor. The practitioner
administering the deep sedation must remain on the premises until the
patient meets the following minimum recovery criteria: conscious and
oriented (e.g., to time, place and person relative to the pre-sedation
condition), stable vital signs (blood pressure, heart rate, and oxygen
saturations), ambulatory, and showing signs of progressively
increasing alertness. The patient must be discharged from the facility
to the care of a responsible adult.
G. POST-SEDATION INSTRUCTIONS
It is highly recommended that written post-sedation instructions be

given to the patient as part of the treatment plan presentation and
also be given to the person accompanying the patient upon discharge
from the facility. The patient should be advised not to drive an
automobile or operate machinery for at least 24 hours, or longer if
drowsiness or dizziness persists. He/she should also be advised to
refrain from consuming alcoholic beverages and sedative drugs, as
they prolong the
effects of the drugs that have been administered. It is highly
recommended that the post-sedation responsibilities of the patient be
acknowledged in writing as part of the informed consent.
VI. SEDATION RECORDS
A. PRE-SEDATION RECORD
At a minimum, a pre-sedation patient evaluation record must be

obtained and must contain the following information:
1. Vital Statistics
- patient's full name, date of birth, gender.

- name and phone number of person to be notified in the
event of an emergency.
- in the case of a minor or an incompetent adult, name of
the parent or legally authorized representative.
2. Medical History Questionnaire
The information on the medical history questionnaire must be

adequate, current, clearly recorded and signed by the patient or

legally authorized representative. It must elicit core information
for determining the correct ASA physical status classification, in
order to assess risk factors in relation to deep sedation, and it
must provide written evidence of a logical process of patient
evaluation.
Core information should include the evaluation and recording of

significant positive findings related to the following:
- general questions
- drug therapy
- sensitivities/allergies
- heart and blood vessels
- brain and nervous system
- blood
- lungs and respiratory system
- endocrine system
- gastrointestinal system
- genitourinary system
- neuromuscular/skeletal system
- ears/nose/throat/eyes
- mental condition
- infectious diseases
- cancer/radiation/chemotherapy
- organ transplants - medical implants
- symptoms review
3. Physical Examination
The physical examination must include the evaluation and

recording of significant positive findings related to:
- general appearance (note obvious abnormalities)
- head, neck and intra-oral examination (particularly
pertaining to airway, such as range of motion, loose
teeth, crowns, dentures, potential obstruction from large
tongue, tonsils, etc.)
- cardiovascular system, including measuring and recording
of vital signs (blood pressure,
- pulse rate, volume and rhythm, auscultation as indicated)
- pulmonary, auscultation and/or other assessments as
required
- examination of other physiologic systems as indicated
(endocrine, neurologic, musculoskeletal, gastrointestinal,
genitourinary)
- other assessments, including laboratory tests as indicated
B. DEEP SEDATION RECORD

When determining the format of the deep sedation record to be used,
practitioners should ensure that the information is clear and readily
understood. The following information must be appropriately
recorded:
- patient name
- date of procedure
- verification of NPO (nothing by mouth) status
- verification of accompaniment for discharge
- pre-operative blood pressure, heart rate, and oxygen saturation
- ASA physical status classification
- names of all drugs administered
- doses of all drugs administered
- time of administration of all drugs
- intravenous type, location of venipuncture, type and amount of
fluids administered
- list of monitors used
- record of systolic and diastolic blood pressure, heart rate and
oxygen saturation at appropriate intervals (automated printout
of monitors may be attached in lieu of handwritten recording of
these signs)
- time of the start and completion of the administration of deep
sedation
- time of the start and completion of the dental procedure(s)
- recovery period
- discharge criteria met: oriented, ambulatory, vital signs stable
(record of blood pressure, heart rate, oxygen saturation)
- time of discharge/name of accompanying adult
- name of practitioner administering the deep sedation
responsible for the case
- notation of any complication or adverse reaction
C. RESUSCITATION RECORD
In the event of a cardiac arrest, a resuscitation record must be

completed. The form for the resuscitation record should be kept with
the defibrillator so that it is immediately available if an emergency
arises. The resuscitation record should include the following:
- patient name
- date/time of arrest
- arrest condition
- time resuscitation stopped
- respiratory management
- cardiac management
- time cardiac shock applied and number of joules
- names of all drugs administered and by whom
- doses of all drugs administered
- time and route of administration of all drugs

- intravenous type, location of venipuncture, type and amount of
fluids administered
D. INCIDENT REPORT
Cases resulting in the need for resuscitation, referral of a patient to a

hospital, or death must be reported to the Registrar immediately. The
initial contact should be made by telephone and must be followed
promptly by the submission of a complete report to the Registrar. A
sample incident report is contained on page 4-10.

CHAPTER 3
AUTHORIZATION FOR NON-HOSPITAL DEEP SEDATION FACILITIES
I. INTRODUCTION
Dental offices, clinics and facilities providing deep sedation services

independent of a hospital setting must have current authorization from the
CDSBC (or the CPSBC). The authorization process is designed to ensure that
the delivery of deep sedation services within the facility conforms to these
Practice Standards. The issuance of an authorization is not, however, an
endorsement of any particular facility, technique or practitioner.
Note: Non-hospital facilities that are authorized to provide general

anaesthetic services in dentistry automatically meet the requirements for
deep sedation and do not require a further authorization.
II. AUTHORIZATION CLASSIFICATIONS
Authorization status is determined by the Committee on the basis of a site

visit by a survey team. The findings of the survey team and the
recommended authorization status are contained in a report which is sent to
the owner of the facility and the CDSBC.
A. FULL AUTHORIZATION
A full authorization is granted when the facility meets the

minimum requirements outlined in this document. This status is valid
for three years from the date of the original site visit. When a full
authorization is granted following provisional or unacceptable for
authorization status, the term of the authorization is for the balance of
the three-year term, starting from the date of the original site visit.
B. PROVISIONAL AUTHORIZATION
A provisional authorization is granted if it has been determined

that the facility has deficiencies in one or more specific areas but is still
considered adequate to maintain minimum standards of patient care.
This authorization status requires follow-up and, in some cases, may
require additional site visits, for which additional fees may be charged.
Deficiencies must be rectified within 60 calendar days, failing which
the provisional authorization will lapse. The facility is then obliged to
stop providing deep sedation services until full authorization is
obtained or the Committee extends the duration of the provisional
authorization.
C. UNACCEPTABLE FOR AUTHORIZATION

Unacceptable for authorization is indicated when deficiencies or
weaknesses are so serious that patient safety is or appears to be at
risk. This status requires immediate cessation of deep sedation
services in the facility. Resumption of deep sedation services in the
facility is only allowed when the deficiencies have been corrected.
III. SURVEY TEAM
The survey team visits the site and is responsible for preparing a joint written
report of its findings and recommending an authorization status to the
Committee. A roster of qualified surveyors is maintained by the CDSBC,
from which the required number of individuals is selected for each survey
team.
A. MEMBERSHIP
1. A dentist currently licensed to practise by the CDSBC or a

practitioner currently licensed to practise by the CPSBC, who
meets the criteria for administering deep sedation.
2. A biomedical engineer currently registered with the Association

of Professional Engineers and Geoscientists of British Columbia,
or a biomedical technologist supervised by a professional
engineer, who has training in deep sedation medical device
technology and associated standards.
B. SELECTION OF SURVEY TEAM – OPPORTUNITY/OBLIGATION TO

RAISE CONCERNS
Appointments to the survey team are made by the CDSBC and are
presented to the registered owner of the facility who has an
opportunity to request an alternate surveyor should there be a concern
regarding bias or conflict of interest. The registered owner has an
obligation to raise any concerns regarding the selection of the survey
team within seven calendar days of being notified of the composition of
the survey team.
C. CONFIDENTIALITY
All documentation and discussions related to the site visit are

confidential and must not be divulged by the survey team or the
CDSBC, except where required by law or as required to administer and
enforce these Practice Standards.
DEEP SEDATION SERVICES IN DENTISTRY CDSBC

3-2
IV. SURVEY FOR AUTHORIZATION OF FACILITY
A. APPLICATION
1. Initial Application
New facilities must obtain an authorization (whether full or

provisional) before providing deep sedation services. An
application for a survey for authorization must be submitted in
writing to the CDSBC at least 45 calendar days before the
anticipated opening of the facility.
2. Renewal Application
An owner of a facility seeking a renewal of its authorization

must submit an application for renewal and a site visit in writing
to the CDSBC at least 45 calendar days before the expiry date
of the existing authorization. A reminder of the impending
expiry of authorization is sent by the CDSBC 60 days prior to
expiry date.
3. Qualifications of Facility Staff
An initial application and a renewal application must identify the

facility staff comprising the Deep Sedation Team and describe
their qualifications.
B. SURVEY SCHEDULING
Upon receipt of an initial application for authorization, an on-site

survey by the appointed survey team will normally take place within
30 calendar days. In the case of a renewal application, the CDSBC will
advise the owner of the facility of the date on which the survey team
will attend, which will normally be at least 30 days before the expiry of
the authorization. If visiting dentists or physicians provide their own
monitoring equipment, this monitoring equipment also must be
available for examination along with their service and maintenance
logbooks. Re-surveys are scheduled as required.
C. FEES FOR SURVEY
Survey fees are intended to offset the cost of site visits and are the
responsibility of the owner of the facility. If a further survey site visit
is required, an additional fee will normally be charged. The fee
schedule is determined from time to time by the CDSBC Council and
payment must be received with the request for renewal and site visit.

D. SITE VISIT
Site visits are normally scheduled during business hours. All members
of the survey team are expected to participate in the site visit at the
same time. During the site visit, the survey team examines the
following to determine if they meet the Practice Standards:
• Physical facilities
• Deep sedation delivery systems
• Physiological monitoring equipment
• Essential airway equipment
• Deep sedation drugs and supplies
• Emergency armamentarium
• Deep sedation protocol, including emergency procedures
• Deep sedation records Equipment records
Satellite Facilities
Deep sedation services may be offered on a satellite basis. In these

circumstances, the practitioner administering deep sedation may bring
to the satellite facility certain equipment and drugs not routinely kept
on the premises. Such equipment and drugs must come from an
authorized facility, and copies of relevant documents, confirming the
authorization, must be supplied to the survey team.
E. SURVEY REPORT
Assessments made by the survey team are based on the requirements

outlined in this document. Weaknesses and/or deficiencies are
specifically identified in relation to requirements, and, where
applicable, time limits for rectification and/or the need for an additional
site visit are specified. The survey team may also offer suggestions
which could lead to an improvement in the functioning of the facility.
However, the registered owner is not obliged to implement these
suggestions, and the results of the site visit are independent of them.
The survey team is responsible for preparing a joint written survey

report with a recommendation. The joint written survey report is
forwarded to the facility owner who then has an opportunity to review
the report for verification of factual data and to provide general
comments. The survey team may prepare a revised survey report
based on those comments. The survey report, together with any
outstanding points of contention or comments, is presented to the
Committee for its consideration.
Upon review of the survey report by the Committee, an appropriate

authorization status is issued, effective as of the date of the original
site visit. Once full authorization has been obtained, the facility owner
will be so advised in writing.

The Committee may accept or reject the recommendation of the
survey team contained in the survey report. In circumstances where
the survey team has recommended a full or provisional authorization
and the
3-4
Committee is having difficulty in accepting that recommendation, the
Committee will advise the facility owner and will, where possible to do
so without jeopardizing patient safety, allow the facility owner to make
his or her views known to the Committee before the Committee makes
a decision on the authorization status of the facility.
Where the Committee concludes that a facility is unacceptable for

authorization, the facility owner will be so advised in writing, and the
owner must immediately cease providing deep sedation services in the
facility until such time as provisional or full authorization is obtained.
F. FOLLOW-UP
A facility that receives a provisional authorization as a result of a site

visit is required to submit a progress report within the time specified.
That report should comprehensively document how the facility has
rectified the deficiencies identified in the survey report. In some
instances, a further site visit may be required.
If a facility owner who has received an unacceptable for authorization

status presents documentation concerning the rectification of
deficiencies which satisfies the Committee that patient safety is no
longer jeopardized, the Committee will issue a provisional
authorization for the facility. A further site visit may be required in
order for the Committee to be satisfied that patient safety is no longer
jeopardized. Additional fees may be charged for such further site
visits.
G. ANNUAL FACILITY SELF-ASSESSMENT AND STATUS

CONFIRMATION
Continued authorization status during the three-year cycle between

site visits is dependent on the annual submission by the facility of a
selfassessment and status confirmation form which has been
completed to the satisfaction of the Committee. (Refer to Appendix III:
SelfAssessment and Status Confirmation Form).
H. SALE OF A FACILITY
Where an authorized facility is sold, both the vendor and the purchaser
have an obligation to advise the Committee that the sale is taking
place. When a facility is sold, the authorization status for that facility
will normally end within 60 calendar days of the sale, and the new

owner must therefore apply for a site visit and authorization as soon
as possible after purchasing a facility. In circumstances where the
Committee is satisfied that the sale of the facility does not require a
new authorization process to take place (e.g. where the sale of the
facility is from a dentist to the dentist's holding company), the
Committee may confirm that the existing authorization status for the
facility will remain in effect despite the sale of the facility.

CHAPTER 4
SAMPLE FORMS
The practice of dentistry involves the exercise of professional judgment in each

particular situation, and flexibility is necessary when it comes to keeping clinical
records. To that end, each practitioner may determine the format and content of
his/her own clinical records. Dentists should, however, keep clinical records that, at
a minimum, contain the information recommended in the forms provided in these
Standards.
The CDSBC does not represent that the forms provided in these Standards are
adequate, sufficient or appropriate, and cannot accept any responsibility for them in
the event of a claim by a patient against a dentist or anyone else. Dentists must
exercise their own professional judgment and seek appropriate professional advice,
including legal advice, in determining what practices and procedures they will employ
in their facilities to minimize the risk of patient complaints or claims.
The following sample forms have accordingly been provided as examples only.
CLINICAL RECORDS/FORMS
• PRE-SEDATION RECORD - MEDICAL HISTORY QUESTIONNAIRE/RISK

ASSESSMENT
• PRE-SEDATION RECORD - PHYSICIAN’S ASSESSMENT
• PATIENT’S CONSENT FOR DENTAL TREATMENT AND DEEP SEDATION
• PRE-SEDATION PATIENT INSTRUCTIONS
• POST-SEDATION PATIENT INSTRUCTIONS
• DEEP SEDATION RECORD
• RESUSCITATION RECORD
• INCIDENT REPORT
EQUIPMENT RECORDS
• PRE-SEDATION CHECKLIST
• EQUIPMENT SPECIFICATIONS

4 -1
PRE-SEDATION RECORD
Date: _____________________________
Name: ___________________________________________________________________________________
Date of Birth: Y____/M_____/D_____  Male  Female Phone: Res. ___________ Work ____________
Home address: ______________________________________________________________________________
City/Province: _____________________________________________________ Postal Code: _______________
Person to notify in case of emergency: _________________________ Rel.: ________ Phone: ________________
If applicable, name of parent or legally authorized representative: ______________________________________
MEDICAL HISTORY QUESTIONNAIRE / RISK ASSESSMENT
Have you ever had a deep sedation?  Yes  No If yes, when? _____________________________________
Any complications?  Yes  No _______________________________________________________________
Any history of familial sedation/anaesthetic complications?  Yes  No ________________________________
Are you being treated for any medical condition at present or within the past two years?  Yes  No
If yes, please explain. _________________________________________________________________________

_____________________________________________________________________________________________
When was your last visit to a physician? ________________ Last complete medical examination? _____________
Have you ever had a serious illness, accident, or required extensive medical care?  Yes  No If yes, please
explain.
_____________________________________________________________________________________________
Have you been hospitalized in the last ten years?  Yes  No If yes, please explain. _____________________
_____________________________________________________________________________________________
Are you taking any prescription or non-prescription drugs?  Yes  No If yes, what is the drug(s), dose(s), and
for how long?
_____________________________________________________________________________________ Have you
ever had a reaction to any drug(s) or been advised against taking any kind of medication?  Yes  No
If yes, please explain. ___________________________________________________________________________

Do you have any sensitivities or allergies ?  Yes  No If yes, please explain. __________________________
_____________________________________________________________________________________________
Do you have any history of family disease?  Yes  No If yes, please explain. _________________________
_____________________________________________________________________________________________
Indicate which of the following you presently have or ever had.
Yes No Yes No Yes No

AIDS .............................   Bleed easily ..................   Congenital heart lesions ..  
Alzheimers .....................   Blood disorders .............   Congestive heart failure ..  
Anemia ..........................   Blood in sputum ............   Cortisone/steroid therapy  
.........................
Angina pectoris ...............   Bronchitis .....................   Diabetes........................  
Arthritis/rheumatism .......   Cancer .........................   Earaches (frequent) ........  
Artificial heart valve ........   Cerebral palsy ..............   Emphysema ..................  

Artificial joints ...............   Changes in appetite .......   Epilepsy or seizures ........  
Asthma .........................   Chest pains ..................   Fainting or dizzy spells ....  
Balance problems ...........   Circulation problems ......   Glandular disorders ........  
Glaucoma ......................   Hypertension ................   Psychiatric treatment ........  
Headaches (severe) ........   Impaired vision .............   Radiation treatment/
Head/neck injuries ..........   Infective endocarditis ....   chemotherapy ..............  
Hearing difficulties ..........   Jaundice ......................   Rheumatic/scarlet fever ....  
Heart disease or attack ....   Kidney disease ..............   Shortness of breath ..........  
Heart murmur ................   Leukemia .....................   Sickle cell disease .............  
Heart pacemaker ............   Liver disease ................   Sinus trouble ...................  
Heart rhythm disorder .....   Lung disease ................   Stomach/intestinal
Yes No Yes No Yes No

Heart surgery .................   Malignant hyperthermia .   problems .........................  
Hemophilia .....................   Medical implant .............   Stroke .............................  
Hepatitis A .....................   Mental/nervous disorder   Temperature intolerance ...  
.......................
Hepatitis B .....................   Mitral valve prolapse ....   Thyroid disease ................  
Hepatitis C .....................   Nosebleeds (frequent) ...   Tuberculosis ....................  
Herpes ...........................   Organ transplant ...........   Ulcers .............................  
High/low blood pressure ..   Persistent cough ...........   Sexually tansmitted disease  
...........................
Hodgkin’s disease ...........   Pulmonary edema .........   Weight gain/loss ..............  
Hyper(hypo) glycemia .....   Positive testing for HIV ..   Other ..............................  
Do you smoke or use other forms of tobacco?  Yes  No __________________________________________

Do you have a history of alcohol and/or drug use or abuse?  Yes  No _______________________________
Have you received treatment for alcohol or drug use or abuse?`  Yes  No ____________________________
Do you currently have, or have you had in the past, any disease, condition or problem not listed?  Yes  No __
If yes, please explain. _________________________________________________________________________ Is

there any problem or medical condition that you wish to discuss in private only?  Yes  No
WOMEN ONLY: Are you pregnant or suspect you might be?  Yes  No Anticipated delivery date? ________
Are you breast feeding?  Yes  No ____________________________________________
Are you taking any birth control pills?  Yes  No _________________________________
NOTE: IT IS IMPORTANT THAT ANY CHANGES IN YOUR

HEALTH STATUS BE REPORTED TO OUR OFFICE.
I confirm that all of the medical and dental information provided above is true to the best of my knowledge, and I
have not omitted any information. I also consent to my physician being contacted if necessary to obtain any
information that is required for my dental care.
Signature ________________________________________________________ Date ____________________

 Patient  Parent  Legally Authorized Representative
Reviewed by dentist _________________________________________________ Date ____________________
CDSBC DEEP SEDATION SERVICES IN DENTISTRY 4-3

PRE-SEDATION RECORD
PHYSICIAN’S ASSESSMENT
Dear Doctor,
Your patient is scheduled for dental treatment under intravenous sedation. Please complete this history and physical
examination form, and return it to our office by _________________. If you have any questions, please call. Thank
you for your assistance.
_______________________________________ Signature of Dentist
Patient’s Name __________________________________________ Date of Birth ___________ Phone ________

Address ___________________________________________________________________________________
City/Province _____________________________________________________ Postal Code _________________
Planned Dental Treatment _____________________________________________________________________
____________________________________________________________________________________________
ALLERGIES
MEDICATION
FUNCTIONAL Cardiac
INQUIRY
Respiratory
Other
PAST ILLNESS Anaesthesia Experience
Other
FAMILY HISTORY Anaesthesia Problems
Other
PHYSICAL General Appearance

EXAMINATION
B/P _____ P. _____ R. _____ Wt. _____ Ht. _____
Head, Neck and Intraoral
Heart
Lungs
Abdomen
Skeletal
CNS
Laboratory Tests
ASA CLASSIFICATION I II III IV V E
Date _____________________________ Physician’s Signature ______________________________________

PATIENT'S CONSENT TO DENTAL TREATMENT
AND DEEP SEDATION
PROCEDURE(S) ____________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
OPERATING DENTIST ________________________________________________________________
PRACTITIONER ADMINISTERING DEEP SEDATION _________________________________________
I consent to the procedure(s) noted above being performed on me. I acknowledge that the
procedure(s), its implications and possible complications have been explained to me, along with the
alternatives, including not having any treatment. I understand the procedure will require deep sedation
and I consent to the administration of this by the above-named practitioner administering the deep
sedation. I also understand that during the course of any treatment, unforeseen circumstances may
arise that could necessitate or make it advisable for an additional or alternative procedure to be
performed, which I also consent to being performed on me.
Signature _____________________________________________________ Date ______________

Witness _______________________________________________________ Date ______________
I acknowledge receiving a copy of the pre- and post-operative instructions, which have been explained
to me. I understand all of the advice given to me by my dentist. After my discharge, I will notify my
doctor and dentist if I experience any acute pain, heavy bleeding from the surgical site, respiratory
problems, or any other post-operative problems.
Signature ______________________________________________________ Date ____________

Witness ________________________________________________________ Date ____________

PRE-SEDATION PATIENT INSTRUCTIONS
For the safe treatment of the patient, the following pre-

sedation instructions must be followed very carefully.
FOOD AND BEVERAGES

• It is essential that the stomach be empty at the time of the anaesthetic appointment.
• Do not eat any solid foods after midnight the night before the anaesthetic appointment.
• Do not drink anything, even water, for at least three hours before the anaesthetic
appointment.
• Do not drink any alcohol within 24 hours of the treatment.
MEDICATIONS
• Regular medication should be taken pre-operatively and in that case, a sip of water is
permitted.
CLOTHING / CONTACT LENSES

• Wear loose casual clothing for the appointment (e.g., short sleeve shirt). Female patients
should wear slacks.
• Do not wear jewelry, hairpins or make-up.

• Remove contact lenses.
SMOKING
• Refrain from smoking before the treatment.
TRANSPORTATION
• You should not drive yourself home or operate any vehicle or machinery for 24 hours after
sedation. A responsible adult should pick you up after the appointment and take you home.
• Public transportation is not recommended.
CHANGE IN HEALTH STATUS

• If your general health deteriorates (e.g., cold, cough, fever, etc.), contact the dental office
before the day of the appointment. If in any doubt, please contact the office to discuss any
change in health status.
If you have any questions, please do not hesitate to ask them. It is important
that you understand all of the implications of this treatment.
POST-SEDATION PATIENT INSTRUCTIONS
(To be given to the patient before the sedation and to a responsible adult picking up the patient
after the sedation)

Following deep sedation, 24 to 36 hours are usually required for
the full effects of the drugs to wear off. It is essential that you
and the adult picking you up follow these instructions.
DISCHARGE FROM OFFICE

• The patient must be discharged into the care of a responsible adult who can accompany
him/her home.
• Arrangements should be made to have a responsible adult remain with the patient for the
balance of the day and during the night.
TRANSPORTATION FROM OFFICE

• Private automobile is preferred; public transportation is not recommended.
FOOD AND BEVERAGES

• Clear liquids are advised for up to 6 hours. Most people can tolerate solids 1 – 2 hours
after sedation and this may help post-operative nausea.
• Do not drink alcohol in any form for 48 hours.
MEDICATIONS
• Resume normal medication as directed by your physician after the appointment.
ACTIVITY RESTRICTIONS
• Do not operate motor vehicles, boats, power tools or machinery for at least 24 hours, or
longer if any drowsiness or dizziness persists.
• Those seeking to operate an aircraft following deep sedation should seek guidance from
applicable aviation authorities and/or their employers (where applicable).
PROBLEMS
• If you experience any acute pain, heavy bleeding from the surgical site, respiratory
problems, or any other post-operative problem, please notify the dental office.

DEEP SEDATION RECORD
Patient’ Name ____________________________________________ Age __________ Date ________________

Weight: kg/lbs Fluids type/total: NPO since: ___________________________
Allergies _________________________________________________ Present Medications __________________

Preoperative Health conditions: ________________________ ASA Classification: I II III IV V E
IV: Angio or BF Gauge ____________ Site: R L DOH ACF FA Other __________________________

Monitors:  Pulse Oximeter  BP  ECG  Pt Stethoscope
 Capnograph  Other _______________________
Pre-operative
Time Medication Dose N2O SpO2 Pulse
TIME:
Start time ______________________ am/pm
Start procedure: __________________ am/pm
End procedure __________________ am/pm
End time ___________am/pm SpO2 X
To recovery room _____am/pm BP  
DISCHARGE CRITERIA HR 
Alert and oriented:  yes  no End Tidal CO2 
Vital signs stable: yes  no To recovery
Discharge time __________________ am/pm
Post Op instructions: yes  no
Side effects:
_____________________________________
Discharged to:  mom  dad  other: ________________________________________
NOTES
_________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Dentist Signature __________________________________

RESUSCITATION RECORD
Name _____________________________________ Time of Arrest ______ Time Resuscitation Stopped _______

Arrest Condition ______________________________________________________________________________
____________________________________________________________________________________________
Output
IV SOLUTION / ADDITIVES IV Amt. Time Amt. Total Site of IV
Started Stopped Remai I.V.
In Time Urine Blood Other
ml ning
Site of IV Cannula
Time Medication Route Given By
Total during resuscitation __________ Total __________
Attending Physician _________________________________
CDSBC
DEEP SEDATION SERVICES IN DENTISTRY 4- 9
INCIDENT REPORT
Date of Incident: _________________________________ Report Date: ______________________
Name of Facility: _________________________________ Phone Number: ____________________

Address: ____________________________________________________________________
City/Province: _____________________________ Postal Code: _______________________
Facility Owner(s): ________________________________ Phone Number: _____________________

Address: ____________________________________________________________________
Operating Dentist: ________________________________ Phone Number: ____________________

Address: ____________________________________________________________________
Practitioner Administering Deep Sedation: ____________________ Phone Number: _____________

Address: ____________________________________________________________________
City/Province: ____________________________________ Postal Code: ________________
Patient: ________________________________ Age ____ Sex ___ Phone Number: _____________

Address: ____________________________________________________________________
City/Province: ____________________________________ Postal Code: ________________
Description of complication, patient status, and disposition of incident:
Description of present patient status:
Forward report to:

Registrar’s Office, College of Dental Surgeons of BC
500 - 1765 West 8th Avenue, Vancouver, BC V6J 5C6
4 - 10 DEEP SEDATION SERVICES IN DENTISTRY

CDSBC
PRE-SEDATION CHECKLIST
A. GAS PIPELINES
1 Secure connections between terminal units (outlets) and anaesthesia
B. ANAESTHETIC MACHINE
1 Line oxygen (40-60 psi) (275-415kPa)

2 Nitrous oxide (40-60 psi) (275-415kpa)
3 Adequate reserve cylinder oxygen pressure
4 Adequate reserve cylinder nitrous oxide content
5 Check for leaks and turn on cylinders
6 Flow meter function of oxygen and nitrous oxide over the working range
C. VAPORIZER
1 Vaporizer filled
2 Filling ports pin-indexed and closed
3 Ensure "on/off" function and turn off
4 Functioning oxygen bypass (flush)
5 Functioning oxygen fail safe
6 Oxygen analyzer calibrated and turned on
7 Functioning mixer (oxygen and nitrous oxide where available)
8 Functioning common fresh gas outlet
D. BREATHING CIRCUIT
1 Correct assembly of circuit to be used

2 Patient circuit connected to common fresh gas outlet
3 Oxygen flowmeter turned on
4 Check for exit of fresh gas face mask
5 Pressurize. Check for leaks and integrity of circuit (e.g. Pethick test for coaxial)
6 Functioning high pressure relief valve
7 Unidirectional valves and soda lime
8 Functioning adjustable pressure relief valve
E. VACUUM SYSTEM
1 Suction adequate
F. SCAVENGING SYSTEM
1 Correctly connected to patient circuit
CDSBC
DEEP SEDATION SERVICES IN DENTISTRY 4- 11
EQUIPMENT SPECIFICATIONS
ITEM
MANUFACTURER
MODEL SERIAL NUMBER
VENDOR OWNER
NORMAL LOCATION
DATE IN SERVICE WARRANTY EXPIRES
TYPE OF APPROVAL LABEL RISK CLASS (3,2,2G, 1) or

APPLIED PART TYPE (B, BF, CF)
OPERATING MANUALS (LOCATION) SERVICE LOG BOOK (LOCATION)
INSPECTION REQUIREMENTS
PERFORMANCE CHECKS
4 - 12 DEEP SEDATION SERVICES IN DENTISTRY

PREVENTIVE MAINTENANCE REQUIREMENTS
OTHER COMMENTS
CDSBC
CDSBC
APPENDIX I
CSA CONTACT INFORMATION
Copies of equipment standards may be obtained by contacting:
CANADIAN STANDARDS ASSOCIATION INTERNATIONAL

13799 Commerce Parkway
Richmond, BC V6V 2N9
Website Address: www.csa-international.org

Telephone Number: 604-273-4581
APPENDIX II
INSPECTION OF MEDICAL DEVICES
The medical devices in a non-hospital deep sedation facility must be inspected and
maintained at a standard equivalent to that used in hospital facilities in British
Columbia. The following table shows a list of medical devices typically found in a
dental deep sedation facility, along with the required inspection procedures and
frequencies. In addition to regular inspection procedures, all equipment must be
maintained as indicated in the manufacturer’s manual. The registered owner(s) of
the facility must be notified by the practitioner administering the deep sedation of
any problems in the facility in order that corrective action can be undertaken
immediately.
DEVICE PROCEDURE FREQUENCY
Anaesthetic Gas Full inspection Two times per year

Machine
(Nitrous Oxide
Delivery Unit)
ECG Monitor Full inspection Annually
Non-Invasive Blood Full inspection Annually

Pressure Monitor
Pulse Oximeter Full inspection Annually
Defibrillator Full inspection Two times per year
Performance check Once per week
Visual check Once per day
Temperature Generic testing Annually

Monitor
APPENDIX III
DEEP SEDATION SERVICES IN DENTISTRY

COLLEGE OF DENTAL SURGEONS
OF BRITISH COLUMBIA
ANNUAL FACILITY SELF ASSESSMENT

AND STATUS CONFIRMATION
NON-HOSPITAL DEEP SEDATION FACILITIES
NAME OF FACILITY:
DIRECTOR / OWNER OF FACILITY:
Date: __________________________________
Continued accreditation during the three year cycle between site visits is dependent upon
confirmation of a successful annual “in-office” assessment of the facility. Please complete the
attached survey and return to the College of Dental Surgeons of BC with copies of the
following:
• Current BLS (CPR LEVEL C) certificates
• Forms for inspection of medical devices since last accreditation survey
Due Date: ___________________________________
ABBREVIATIONS
A = Acceptable
I = Needs Improvement
U = Unacceptable
NT = Not Tested
NA = Not Applicable
DEEP SEDATION SERVICES IN DENTISTRY
FACILITY STAFF QUALIFICATIONS
Person providing sedation, if not the operating dentist:
Name ______________________________________  BLS  ACLS

 Certified Specialist  General Practitioner
Name ______________________________________  BLS  ACLS

 Certified Specialist  General Practitioner
Operating Dentist(s)
Name ______________________________________  BLS  ACLS
Name ______________________________________  BLS  ACLS
Deep Sedation Assistant
Name _____________________________________________  BLS

 Registered Nurse  Dentist  Physician  OMAAP
Name _____________________________________________  BLS

Operative Assistant(s)
Name _____________________________________________  BLS
Name _____________________________________________  BLS
Name _____________________________________________  BLS
Recovery Supervisor(s)
Name ______________________________________  BLS  ACLS

Name ______________________________________  BLS  ACLS

1
PHYSICAL FACILITIES
Layout and Design
SPACE A I U COMMENTS ACTION

TAKEN
Reception / waiting area
Administrative activities
Pre-operative evaluation /
preparation for deep
sedation
Operative / surgical
treatment area
Post-sedation recovery
area
Instrument preparation /
sterilization area
Storage
Staff activities
OPERATING AREA A I U
Size
Placement of equipment
Lighting
Electrical supply
Oxygen
Suction
Chair or Table
Range of movement
Adjustable headrest
Padding
IV provisions
Grounded
RECOVERY AREA A I U
Separate area
Patient visibility
Lighting
Electrical supply
Oxygen
Suction
2 DEEP SEDATION SERVICES IN DENTISTRY CDSBC

Utilities and Backup Systems
ELECTRICAL SUPPLY A I U COMMENTS ACTION TAKEN
Number of outlets
Condition of receptacles
Backup power
LIGHTING A I U
(Operating/
Recovery Areas)
Amount
Color
Backup lighting
Utilities and Backup Systems
SUCTION A I U
Source
Location  In
suite
 Outside suite
Locked access
Location of key
Cannot be turned off
by accident
Backup suction
GENERAL FACILITY OPERATING REQUIREMENTS

INFECTION A I U COMMENTS ACTION TAKEN
CONTROL
Facilities
Equipment
Procedures
Disposal of sharps
Disposal of other
materials
DRUG CONTROL A I U COMMENTS ACTION TAKEN

Appropriate storage
Identification
Narcotics locked
3
SAFETY A I U
REQUIREMENTS
Posted where
appropriate
Safety plans for
nonmedical
emergencies:
 Electrical failure
 Fire
 Earthquake
MEDICAL A I U
EMERGENCIES
Written protocol
 Procedures
 Staff duties
Emergency equipment
organized and
available
Emergency phone
numbers posted
Operational plan to
transport anesthetized
patient from facility
DEEP SEDATION ARMAMENTARIUM

Deep Sedation Delivery System
ANAESTHETIC GAS A I U COMMENTS ACTION TAKEN

MACHINE #1
Condition
Manufacturer
Serial #
CSA approved Yes
No
Last inspection
___/___
Routine maintenance
Last service
___/___
Log book
ANAESTHETIC GAS A I U
MACHINE #2
Condition
Manufacturer
Serial #
CSA approved Yes No

Last inspection
___/___
Routine maintenance
Last service
___/___
Log book
GASES / PIPING / A I U
CONDUCTING
SYSTEMS
Condition
Safety indexing
systems
Reserve supply oxygen
Pre-sedation checklist
Gas storage
 In suite
 Outside suite
 Locked
 Location of key
Turned on/off by
Alarm / manifold
system 
Present
 Not present
Scavenging system
Last inspection
___/___
Routine maintenance
Last service
___/___
Log book
Physiological Monitoring Equipment
STETHOSCOPES A I U COMMENTS ACTION TAKEN

 Precordial
 Esophageal
 Paratracheal
BLOOD PRESSURE A I U
MONITOR
Condition
5
Manufacturer
Serial #
Last inspection
___/___
Routine maintenance
Last service
___/___
Log book
ECG #1 A I U
Condition
Manufacturer
Serial #
Last inspection
___/___
Routine maintenance
Last service
___/___
Log book
ECG #2 A I U
Condition
Manufacturer
Serial #
Last inspection
___/___
Routine maintenance
Last service
___/___
Log book
TEMPERATURE A I U
MONITOR
Condition
Manufacturer
Serial #
Last inspection
___/___
Routine maintenance
Last service
___/___
Log book
PULSE OXIMETER #1 A I U COMMENTS ACTION TAKEN

Condition
Manufacturer

Serial #
Last inspection
___/___
Routine maintenance
Last service
___/___
Log book
PULSE OXIMETER #2 A I U
Condition
Manufacturer
Serial #
Last inspection
___/___
Routine maintenance
Last service
___/___
Log book
OXYGEN GAS A I U
ANALYZER
Condition
Manufacturer
Serial #
Last inspection
___/___
Routine maintenance
Last service
___/___
Log book
BATTERY POWERED A I U
PHYSIOLOGICAL
MONITOR
 ECG
 Pulse oximeter
 Other
Condition
Manufacturer
Serial #
Last inspection
___/___
Routine maintenance
Last service
___/___
Log book
7
OTHER EQUIPMENT A I U
Condition
Manufacturer
Serial #
Last inspection
___/___
Routine maintenance
Last service
___/___
Log book
Essential Airway Equipment
BAG & MASK A I U COMMENTS ACTION

TAKEN
Airways
 Oral
 Nasopharyngeal
Ventilation apparatus
with adapter to fit
tracheal tube
Facemasks
Oxygen source
SUCTION APPARATUS A I U
Suction source
Tonsil suction
Suction catheters
Nasogastric tubes
INTUBATION A I U
Laryngoscope (2)
Preferred blades
Spare batteries/bulbs
Endotracheal tubes
 Appropriate sizes
 Cuffed
 Non-cuffed
Syringe for inflating cuff
Lubricants
Stylettes
Forceps (Magill)

Emergency airway
adjuncts
 Tracheotomy set
 Cricothyrotomy set
 Laryngeal mask
 Lighted stylette
Deep Sedation Drugs and Supplies
SEDATIVE DRUGS A I U COMMENTS ACTION TAKEN

Quantity
Identification
Storage
Drug inventory record
Present Expiry
 Brietal ___/___
 Pentothal ___/___
 Atropine ___/___
 Succinycholine ___/___
 Halothane ___/___
 Isofluorane ___/___
 Ethrane ___/___
 Propofol ___/___
 Other ___/___
 Other ___/___
VENIPUNCTURE A I U
Cannulas needles
IV Catheters
Administration sets
 Adult
 Pediatric
Intravenous stand
Intravenous solutions Expiry
 D5W ___/___
 Normal saline ___/___
 D5NS ___/___
 Other ___/___
 Other ___/___
9
Emergency Armamentarium in Addition to Essential Airway Equipment

Deep Sedation Standards

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The College is updating its

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DEEP SEDATION SERVICES

College of Dental Surgeons of BC

Copyright © 2008. All rights reserved

Updated: August 2008 (essential drugs list added September 2019)

Regulating dentistry in the public interest

C. DEEP SEDATION ASSISTANT .................................................................................................. 2-2

D. OPERATIVE ASSISTANT ......................................................................................................... 3-2

E. RECOVERY SUPERVISOR ....................................................................................................... 2-3

II. PHYSICAL FACILITIES ........................................................................................... 2-3

1. Space Requirements ......................................................................................................... 2-

1. Electrical Supply / Lighting ................................................................................................. 2-

B. DRUG CONTROL ................................................................................................................... 2-5

C. SAFETY REQUIREMENTS ........................................................................................................ 2-5

D. MEDICAL EMERGENCY PROCEDURES ....................................................................................... 2-5

IV. DEEP SEDATION ARMAMENTARIUM ....................................................................... 2-6

CDSBC DEEP SEDATION SERVICES IN DENTISTRY

1. Equipment Standards ........................................................................................................ 2-

C. PHYSIOLOGICAL MONITORING EQUIPMENT ............................................................................. 2-7

D. ESSENTIAL AIRWAY EQUIPMENT ............................................................................................ 2-8

1. Bag and Mask Management ................................................................................................ 2-

1. Sedative Drugs ................................................................................................................. 2-

1. Emergency Equipment ..................................................................................................... 2-

B. INFORMED CONSENT .......................................................................................................... 2-12

C. PRE-SEDATION INSTRUCTIONS ............................................................................................ 2-13

D. ADMINISTRATION OF DEEP SEDATION .................................................................................. 2-13

E. MONITORING ..................................................................................................................... 2-14

F. RECOVERY AND DISCHARGE ................................................................................................ 2-14

G. POST-SEDATION INSTRUCTIONS .......................................................................................... 2-15

VI. SEDATION RECORDS ............................................................................................ 2-15

1. Vital Statistics ................................................................................................................ 2-

C. RESUSCITATION RECORD .................................................................................................... 2-17

D. INCIDENT REPORT .............................................................................................................. 2-18

CDSBC DEEP SEDATION SERVICES IN DENTISTRY

B. PROVISIONAL AUTHORIZATION ............................................................................................. 3-1

C. UNACCEPTABLE FOR AUTHORIZATION .................................................................................... 3-2

III. SURVEY TEAM ...................................................................................................... 3-2

B. SELECTION OF SURVEY TEAM – OPPORTUNITY/OBLIGATION TO RAISE CONCERNS ..................... 3-2

C. CONFIDENTIALITY ................................................................................................................ 3-2

IV. SURVEY FOR AUTHORIZATION OF FACILITY .......................................................... 3-3

1 Initial Application ............................................................................................................... 3-

C. FEES FOR SURVEY ................................................................................................................ 3-3

D. SITE VISIT .......................................................................................................................... 3-3

E. SURVEY REPORT .................................................................................................................. 3-4

F. FOLLOW-UP ......................................................................................................................... 3-5

G. ANNUAL FACILITY SELF-ASSESSMENT AND STATUS CONFIRMATION .......................................... 3-5

H. SALE OF FACILITY ................................................................................................................ 3-4

INCIDENT REPORT ........................................................................................................ 4-10

CDSBC DEEP SEDATION SERVICES IN DENTISTRY

CDSBC DEEP SEDATION SERVICES IN DENTISTRY

Deep sedation procedures in dentistry allow patients to have dental

The College of Dental Surgeons of British Columbia (the “CDSBC”) has

It is recognized that there is a continuum of sedation, and, as a patient

In this document, the following definitions apply:

ACLS: Advanced Cardiac Life Support

BLS: Basic Life Support (CPR Level C)

CSA: Canadian Standards Association.

CDSBC DEEP SEDATION SERVICES IN DENTISTRY 2- 1