(1) Minimum standards for monitoring patients for general anesthesia shall include the following:

(a) preoperative:

(i) vital signs - to include blood pressure, pulse and respiratory rate. Temperature may be necessary, and

(ii) electrocardiac monitoring.

(b) intraoperative:

(i) vital signs - to include blood pressure, pulse and respiratory rate to be taken and recorded every five minutes, and

(ii) precordial stethoscope used to monitor respiratory rate and pulse rate, and

(iii) pulse oximetry, and

(iv) continuous electrocardiac monitoring, and

(v) an intravenous line, and

(vi) continuous monitoring of skin and mucosal color, and

(vii) additional monitoring devices as indicated.

(c) postoperative:

(i) vital signs - to include blood pressure, pulse, respiratory rate recorded at the completion of the procedure and prior to discharge, and

(ii) the patient must not leave the recovery area until the cardiovascular and respiratory stability are assured and the patient is awake and oriented.

(2) The minimum standards for monitoring conscious sedation patients shall include the following:

(a) preoperative:

(i) vital signs to include blood pressure, pulse and respiratory rate,

(ii) blood pressure monitoring for pediatric patients only as indicated.

(b) intraoperative:

(i) monitoring need not be applied to the fully-awake and alert patient.

(ii) vital signs - to include blood pressure, pulse and respirations to be monitored and recorded at appropriate intervals. Only appropriate blood pressure monitoring for pediatric patients need be recorded,

(iii) a precordial stethoscope used to continually monitor respiration and pulse rate, and

(iv) pulse oximetry, and

(v) continuous monitoring skin and mucosal color.

(c) postoperative:

(i) vital signs, blood pressure pulse and respirations should be taken at completion of the procedure and prior to discharge,

(ii) only appropriate blood pressure monitoring for pediatric patients need be recorded,

(iii) prior to discharge cardiovascular and respiratory systems must be adequate.

(3) Minimum standards for monitoring nitrous oxide/oxygen sedation used alone or in conjunction with a single oral sedative agent shall include the following:

(a) when the dentist who administers the nitrous oxide/oxygen is not in the operatory there must be a dental auxiliary who remains with the patient and provides direct observation. The dental auxiliary must have specific instruction in the observation of nitrous oxide/oxygen sedated patients and shall monitor the patient until discharged.

(4) During dental procedures the facility must be staffed by supervised monitoring personnel all of whom are capable of handling procedures, problems, and emergency incidents and have successfully completed basic life support.

(a) With respect to a full general anesthesia facility, in addition to the dentist and dental assistant, there must be at least one person present to monitor vital signs. That person must be either:

(i) an anesthesiologist licensed to practice medicine in the state of Montana; or

(ii) a certified registered nurse anesthetist recognized in that specialty by the Montana Board of Nursing; or

(iii) a trained health professional who has received at least one year of postgraduate training in the administration of general anesthesia.

(b) With respect to light general anesthesia, in addition to the dentist and dental assistant, there must be one person present whose duties are to monitor vital signs. This person must be trained in basic life support and their task dedicated to monitoring.

(c) When conscious sedation is used, the dentist shall be qualified and permitted to administer the drugs and appropriately monitor the patient, and have successfully completed a course in advanced cardiac life support. In addition to the dentist, at least one other person on staff and present in the office must have successfully completed basic life support.