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15.3.3.6 Nitrous Oxide Scavenging in Dental

  • Wednesday, July 22, 2020 11:30 AM
    Message # 9118711

    Ok so 15.3.3.6.1.1 says:


    WAGD shall be provided where dental treatment involves general anesthesia or deep sedation. 


    So if a dentist has oxygen and nitrous oxide and does deep sedation through IV they need WAGD? Even if they don't use inhaled anesthetic agents?

  • Thursday, July 23, 2020 9:59 AM
    Reply # 9120665 on 9118711
    Jay D'Agostino escribió:

    Ok, entonces 15.3.3.6.1.1 dice:


    Se proporcionará WAGD cuando el tratamiento dental implique anestesia general o sedación profunda. 


    Entonces, si un dentista tiene oxígeno y óxido nitroso y tiene una sedación profunda por vía intravenosa, ¿necesita WAGD? ¿Incluso si no usan agentes anestésicos inhalados?

    Dear Jay, in my opinion, where a nitrous oxide outlet station is installed, a WAGD inlet station should be installed. The code establishes that where halogenated agents or nitro oxide are supplied, it must counter with WAGD stations.

    5.1.5.16 WAGD networks shall provide a WAGD inlet in all

    locations where nitrous oxide or halogenated anesthetic gas is

    intended to be administered.


  • Thursday, July 23, 2020 1:28 PM
    Reply # 9121078 on 9118711

    Jose,


    Jay was referencing Chapter 15 Dental, not Chapter 5 Cat 1.  WAGD is not required in Chapter 15 Cat 2 Dental.  Only " Nitrous Oxide Scavenging"


    15.4.1.4 The vacuum systems shall be dental vacuum and nitrous oxide scavenging.


    Jay,


    Unfortunately I don't see another option.  Code calls for WAGD even if they won't use it.  Logically I see you point, but the code is an imperfect beast.  Seems like an un-needed expense for the client.


    15.1.1 Category 1 dental piped gas and piped vacuum system requirements shall be applied in facilities where general anesthesia and deep sedation is performed, as defined in 3.3.65.1 and 3.3.65.2.


    15.3.2.1.8 WAGD Systems. Category 1 systems shall comply with 5.1.3.8, except as follows:

    (1) Medical WAGD pumps shall be permitted to be simplex.

    (2) The facility staff shall develop their emergency plan to deal with the loss of WAGD.


    I'd be willing to bet there are a lot of surgery centers that are in the same boat.  


    P.S.

    Look out for vacuum exhaust and dental air intake locations as well....  They aren't defined.

  • Friday, July 24, 2020 7:04 AM
    Reply # 9122553 on 9118711

    I submitted a proposal for 5.1.1.2 to include the word Inhaled general anesthesia or deep sedation.  


    My substantiation was that the rules in chapter 5 for piping do not apply when the anesthesia is administered via injection. A WAGD inlet will not provide any protection for the surgery team under that circumstance.

    See the definition for Anesthetic 3.3.7: As used in this code, applies to any inhalational agent used to produce sedation, analgesia, or general anesthesia. (MED)


    It was rejected with this explanation:

    The risks are the same whether the anesthetic are inhaled or given via injection. The medical gas and vacuum system need to be designed and installed based on the level of anesthesia rather than how the anesthesia is administered.


    It is interesting to search NFPA 99 for the word inhalational.  It is mentioned multiple times, just not in chapter 5.



  • Friday, July 24, 2020 9:37 AM
    Reply # 9122809 on 9118711

    Peter thank you for your comments, sorry that my intervention was incomplete, I was referring to, as you well mentioned, that if General Anesthesia or deep sedation is performed, which is established in the risk analyzes as a determinant to establish the category of the facility, a dental center or any other health care facility must have a WAGD or Scavenging system,

    As Corky mentions, in this particular topic of intravenous anesthesia (TIVA TCI), this procedure is in full evolution, to give analgesia or deep sedation the intravenous bolus is widely used, however when we go to general anesthesia, the use of combined anesthesia, halogenated agents and intravenous anesthetics is widely used, this responds to many conditions of the patient as well as the school of the anesthesiologist, this explains the need to maintain the WAGD / Scavenging stations where general anesthesia is administered. It is very likely that in the future halogenated agents will no longer be used entirety, when we get to that, it will be necessary to review that requirement. That is my opinion in the referred topic


  • Saturday, July 25, 2020 10:26 AM
    Reply # 9124480 on 9118711

    Jose,  

    Well said. I fully agree. 

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