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<regulation prefix="Regulation" num=".03" citation="COMAR 10.44.12.03" title_num="10" subtitle_num="44" chapter_num="12" heading="Definitions.">
  <paragraph num="A.">
    <text>In this chapter, the following terms have the meanings indicated.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Terms Defined.</text>
    <paragraph num="(1)">
      <text>“Accredited facility” means a facility holding current certification from:</text>
      <paragraph num="(a)">
        <text>The Accreditation Association for Ambulatory Health Care (AAAHC);</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The Joint Commission on Accreditation of Healthcare Organizations (JCAHO);</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The Joint Commission Ambulatory Health Care Accreditation (JCAHCA);</text>
      </paragraph>
      <paragraph num="(d)">
        <text>The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF); or</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Their successor organizations.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>“Administration evaluation” means an evaluation by the Board or its designee to determine if an applicant for a permit demonstrates knowledge of management of emergencies and anesthesia techniques to a level that meets the requirements of this chapter.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>“Advanced Cardiac Life Support (ACLS)” means a certification that an individual has successfully completed an advanced cardiac life support course offered by the American Heart Association or other entity approved by the Board.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>“Anesthesia” means an artificially induced insensibility to pain usually achieved by the administration of gases or the use of drugs.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>“Anesthesia and sedation” means:</text>
      <paragraph num="(a)">
        <text>Moderate sedation;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Deep sedation; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>General anesthesia.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>Anxiolysis.</text>
      <paragraph num="(a)">
        <text>“Anxiolysis” means a drug-induced state, with or without nitrous oxide/oxygen to decrease anxiety, in which patients respond normally to tactile stimulation and verbal commands. Although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are maintained and require no assistance.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>“Anxiolysis” includes a single dose of one sedative, narcotic, class of drugs, or medication prescribed by the treating dentist and taken the evening before a procedure or the morning of a procedure, or both, provided that the dosage complies with the definition of anxiolysis under §B(6)(a) of this regulation.</text>
      </paragraph>
      <paragraph num="(c)">
        <text>“Anxiolysis” does not include the administering, prescribing, or dispensing of any other sedative, narcotic, class of drugs, or medication for the purpose of anesthesia by a dentist to a patient to be used for anesthesia or sedation, to be taken the evening before a procedure or the morning of a procedure.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>“Board” means the State Board of Dental Examiners.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>“Certified registered nurse anesthetist” means a registered nurse who is currently certified to practice nurse anesthesia in Maryland.</text>
    </paragraph>
    <paragraph num="(9)">
      <text>“Deep sedation” means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Cardiovascular function is usually maintained.</text>
    </paragraph>
    <paragraph num="(10)">
      <text>“Dentist” means an individual who holds a current license to practice dentistry in Maryland.</text>
    </paragraph>
    <paragraph num="(11)">
      <text>“Facility” means any location in which anesthesia or sedation is administered for the practice of dentistry.</text>
    </paragraph>
    <paragraph num="(12)">
      <text>“Facility evaluation” means an on-site inspection by the Board or its designee to determine if a facility where the applicant proposes to provide anesthesia and sedation is adequately supplied, equipped, staffed, and maintained in a condition to support the provision of anesthesia and sedation services in a manner that meets the requirements of this chapter.</text>
    </paragraph>
    <paragraph num="(13)">
      <text>“General anesthesia” means a drug-induced loss of consciousness during which patients are not arousable even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation, drug-induced depression, or changes in neuromuscular function. Cardiovascular function may be impaired.</text>
    </paragraph>
    <paragraph num="(14)">
      <text>“General anesthesia administration permit” means a permit that was issued by the Board before January 4, 2010, that authorized the dentist to whom the permit was issued to administer general anesthesia for the practice of dentistry.</text>
    </paragraph>
    <paragraph num="(15)">
      <text>“General anesthesia facility permit” means a permit that was issued by the Board before January 4, 2010, that authorized the administration of general anesthesia for the practice of dentistry in the facility named in the permit.</text>
    </paragraph>
    <paragraph num="(16)">
      <text>“Incident” means dental treatment performed on a patient under moderate sedation, deep sedation, or general anesthesia with unforeseen complications.</text>
    </paragraph>
    <paragraph num="(17)">
      <text>“Moderate enteral sedation” means a drug-induced depression of consciousness through the gastrointestinal tract or oral mucosa during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.</text>
    </paragraph>
    <paragraph num="(18)">
      <text>“Moderate parenteral sedation” means a drug-induced depression of consciousness that bypasses the gastrointestinal tract or oral mucosa during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.</text>
    </paragraph>
    <paragraph num="(19)">
      <text>“Moderate sedation” means a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is maintained.</text>
    </paragraph>
    <paragraph num="(20)">
      <text>“Parenteral” means a technique of administration in which the drug bypasses the gastrointestinal tract, that is, through an intramuscular, intravenous, intranasal, submucosal, subcutaneous, or intraosseous technique.</text>
    </paragraph>
    <paragraph num="(21)">
      <text>“Parenteral sedation administration permit” means a permit that was issued by the Board before January 4, 2010, that authorized the dentist to whom the permit was issued to administer parenteral sedation for the practice of dentistry.</text>
    </paragraph>
    <paragraph num="(22)">
      <text>“Parenteral sedation facility permit” means a permit that was issued by the Board before January 4, 2010, that authorized the administration of parenteral sedation for the practice of dentistry in the facility named in the permit.</text>
    </paragraph>
    <paragraph num="(23)">
      <text>“Pediatric Advanced Life Support (PALS)” means a certification that an individual has successfully completed a pediatric advanced life support course offered by the American Heart Association or other entity approved by the Board.</text>
    </paragraph>
    <paragraph num="(24)">
      <text>“Physician” means a physician, including a doctor of osteopathy, who holds a current license to practice medicine in Maryland.</text>
    </paragraph>
    <paragraph num="(25)">
      <text>“Renewal evaluation” means an on-site inspection by the Board or its designee before the renewal of a permit to determine if a facility where the applicant proposes to provide anesthesia and sedation is adequately supplied, equipped, staffed, and maintained in a condition to support the provision of anesthesia and sedation services in a manner that meets the requirements of this chapter.</text>
    </paragraph>
    <paragraph num="(26)">
      <text>“Sedation” means the reduction of stress or excitement by the administration of a drug that has a soothing, calming, or tranquilizing effect.</text>
    </paragraph>
  </paragraph>
</regulation>