(a) For purposes of this rule, the following definitions apply:      
        (1) "Pediatric patient" means a patient younger than 13 years of age.       
        (2) "Board-approved education program" means an in-person or online program provided by a recognized continuing education provider pursuant to §104.2 of this title (relating to Providers) and any subsequent amendments.       
      (b) On or after September 1, 2019, a permit holder may not administer sedation/anesthesia under a level 2, level 3, or level 4 permit to a pediatric patient unless the permit holder has completed the requirements of paragraphs (1) or (2) of this subsection. Permit holders must have:      
        (1) completed a university or hospital-based residency at least 12 months in length. All permit holders completing a university or hospital-based residency after September 1, 2019, must confirm that during the residency, the permit holder completed satisfactory management of sedation/anesthesia involving pediatric patients sedated/anesthetized at the highest level of permit held. The cases must include: (i) at least three (3) live cases in which the permit holder is the primary sedation/anesthesia provider, or (ii) at least fifteen (15) cases involving pediatric patients sedated/anesthetized where no more than seven (7) cases are observed on live patients or high-fidelity sedation simulators, and at least eight (8) cases are performed as part of a hands-on high-fidelity sedation simulation center or program; or       
        (2) completed a board-approved education program that includes a minimum of sixteen (16) hours of didactic training and instruction in sedation/anesthesia of pediatric patients. The entire board-approved education program, including all didactic and clinical requirements, must be completed within a two-year period of beginning the Board-approved program. Successful completion of the program must include passing an evaluation to demonstrate satisfactory completion of the course requirements. Didactic education must include:                  (A) pre-anesthetic patient assessment/evaluation for pediatric patients;                   (B) physical evaluation and medical history of pediatric patients, including obesity, limited neck mobility, micro/retrognathia, macroglossia, Mallampati score, and limited oral opening;                   (C) pediatric anatomical and physiological differences;                   (D) pediatric respiratory assessment, including airway anatomy, physiology, and management;                   (E) informed consent by parent, guardian, or care-giver;                   (F) sedation/anesthesia pharmacology;                   (G) sedation/anesthesia management of pediatric patients;                   (H) pediatric patient monitoring;                   (I) peri-operative complications and emergencies;                   (J) emergency management of pediatric patients, including pediatric anesthesia equipment and resuscitation supplies;                   (K) sedation/anesthesia technique;                   (L) sedation/anesthesia record keeping;                   (M) patient recovery and discharge;                   (N) pediatric case selection and reference behavior scale; and                   (O) permit holders shall have completed satisfactory management of sedation/anesthesia involving pediatric patients sedated/anesthetized at the highest level of permit held. All of the cases must be performed and documented under the on-site instruction and direct supervision of a licensed dentist authorized to administer sedation/anesthesia to pediatric patients. The cases must include: (i) at least three (3) live cases in which the permit holder is the primary sedation/anesthesia provider, or (ii) at least fifteen (15) cases involving pediatric patients sedated/anesthetized where no more than seven (7) cases are observed on live patients or high-fidelity sedation simulators, and at least (8) cases are performed as part of a hands-on high-fidelity sedation simulation center or program.         
      (c) A permit holder is authorized to administer sedation/anesthesia under a level 2, level 3, or level 4 permit to a pediatric patient if they have completed the requirements above and have requested and received authorization from the Board to administer sedation/anesthesia to pediatric patients. Board staff shall promulgate appropriate forms for permit holders qualifying under subsection (b)(1) and (b)(2) of this section. The permit holder must attest to their advanced training satisfying the requirements of subsection (b)(1) or (b)(2) of this section, and will be required to produce proof of completion as part of a permit inspection or an investigation of a complaint involving sedation/anesthesia of a pediatric patient.     
      (d) The education hours described in subsection (b)(2) of this section can be applied towards the permit holder's continuing education requirement for maintaining a sedation/anesthesia permit.     
      (e) If qualifying under subsection (b)(2) of this section, the didactic and clinical training described in subsection (b)(2) of this section may not be fulfilled by the same didactic and clinical training used to fulfill the requirements for initial sedation/anesthesia permit issuance.     
     Source Note:        The provisions of this §110.17 adopted to be effective September 24, 2018, 43 TexReg 6278; amended to be effective June 12, 2019, 44 TexReg 2839