(1) The outpatient center must:

(a) prohibit the use of flammable anesthesia;

(b) have a policy which defines the types of anesthesia that will be used within the facility. Similarly, the outpatient center must address in this policy the level of American Society of Anesthesiologists (ASA) Physical Status Classification System level appropriate to receive surgical services in these types of facilities;

(c) conduct an assessment prior to the patient's admission as well as prior to surgery to evaluate the risk of anesthesia and of the procedure to be performed; and

(d) have policies that address the basis or criteria used in conducting the assessments.

(2) Supplies and exhaust systems for windowless anesthetizing locations must be arranged to automatically vent smoke and products of combustion.

(a) Ventilating systems for anesthetizing locations using general anesthesia must be provided that automatically:

(i) prevent recirculation of smoke originating within the surgical suite; and

(ii) prevent the circulation of smoke entering the system intake, without, in either case, interfering with the exhaust function of the system.

(3) Anesthesia must be administered only by:

(a) a qualified anesthesiologist;

(b) a physician qualified to administer anesthesia;

(c) a certified registered nurse anesthetist (CRNA);

(d) an anesthesiologist assistant is a person who:

(i) works under the direction of an anesthesiologist;

(ii) is in compliance with all applicable requirements of Montana state law, including any licensure requirements the state of Montana imposes on nonphysician anesthetists; and

(iii) is a graduate of a medical school-based anesthesiologist's assistant educational program that:

(A) is accredited by the Committee on Allied Health Education and Accreditation; and

(B) includes approximately two years of specialized basic science and clinical education in anesthesia at a level that builds on a premedical undergraduate science background.

(e) an anesthesiologist assistant may administer anesthesia when under the direct supervision of an anesthesiologist. The anesthesiologist must be immediately available if needed, meaning:

(i) the supervising anesthesiologist is physically present in the facility; and

(ii) is prepared to immediately conduct hands on intervention if needed.

(f) a supervised trainee in an approved educational program under the supervision of a licensed anesthesiologist; or

(g) a trainee who is a physician in training to be an anesthesiologist in a recognized graduate medical education program, or a student in a recognized nurse anesthesia or anesthesiologist assistance education program may administer anesthesia when supervised by the physician performing the operation.

(4) Before discharge, each patient must be evaluated by a physician or by an anesthetist in accordance with applicable state health and safety laws, standards of practice, and facility policy. This postanesthesia assessment must include evaluation of:

(a) respiratory function, including respiratory rate, airway patency, and oxygen saturation;

(b) cardiovascular function, including pulse rate and blood pressure;

(c) mental status and level of consciousness, or both;

(d) temperature;

(e) pain;

(f) nausea and vomiting; and

(g) postoperative hydration.