Administration of Nitrous Oxide by DPM
Permit Required
A podiatrist may administer nitrous oxide (N2O) to patients if the podiatric physician holds the appropriate TDLR permit. As long as the podiatrist is performing N2O for purposes of the practice of Podiatry, they are authorized to employ N2O.
Authority
The utilization of N2O by a podiatrist is an approved modality pursuant to TDLR Rules "Nitrous Oxide/Oxygen Inhalation Conscious Sedation Guidelines" and Attorney General Opinion MW-435 (02/01/1982) - PDF.
It is further noted that the TDLR N2O rules do not explicitly address whether or not a podiatrist is authorized to administer moderate sedation, such as versed. Persons who administer anesthetics such as nitrous oxide are subject to liability for injuries caused to a patient by their negligent administration thereof.
Delegation of Authority
Conscious sedation of a patient by nitrous oxide shall be induced, maintained, and continuously supervised only by the podiatric physician or by the assistant under continuous direct supervision of the podiatric physician. The nitrous oxide shall not be flowing if the podiatric physician is not present in the room. The podiatric physician must be present at all-times and cannot delegate the administration of nitrous oxide to any other person.
Office Setting
Office-based procedures should not be a substitute to treat a patient outside a (properly credentialed) hospital or ambulatory surgical clinic or center setting when the standard of care dictates that a patient be treated in those settings; for the health, safety and well-being of the patient.
Podiatry offices/practices must meet all cleanliness, sterility and infection-control standards; for the health, safety and well-being of the patient.
Pre-Operative Patient Evaluation
It is imperative during the Pre-Operative Evaluation that the podiatric physician evaluate and document in the patient's medical record, prior to the nitrous oxide/oxygen inhalation conscious sedation procedure, the patient's health and medical status to ensure that nitrous oxide/oxygen inhalation conscious sedation is medically appropriate.
