The following words and terms when used in this chapter shall have the following meanings, unless the contents indicate otherwise:(1) ACLS--Advanced Cardiac Life Support, as defined by the AHA.(2) AED--Automatic External Defibrillator.(3) AHA--American Heart Association.(4) Anesthesia--Use of local anesthetics, analgesics, anxiolytics, or hypnotics to create a loss of feeling, sensation, or consciousness by interrupting or depressing nerve and/or brain function.(5) Anesthesia Services--The use of anesthesia for the performance of Level II- IV services.(6) Anxiolytics--Dangerous or scheduled drugs used to provide sedation or to treat episodes of anxiety.(7) ASHI--American Safety and Health Institute.(8) ASA--American Society of Anesthesiologists.(9) BLS--Basic Life Support, as defined by the AHA.(10) Certified registered nurse anesthetist (CRNA)--A person licensed by the Texas Board of Nursing (TBON) as a certified registered nurse anesthetist.(11) Dangerous drugs--Medications defined by Chapter 483, Texas Health and Safety Code. Dangerous drugs require a prescription but are not included in the list of scheduled drugs. A dangerous drug bears the legend "Caution: federal law prohibits dispensing without a prescription" or "Prescription Only."(12) Deep sedation--a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.(13) General anesthesia--a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.(14) Hypnotics--Dangerous or scheduled drugs that alter consciousness. This includes inhaled anesthetics and nonvolatile anesthetic agents such as barbiturates, benzodiazepines, opioids, Etomidate, Propofol, and Ketamine.(15) Level I services.(A) Delivery of narcotic analgesics or anxiolytics by mouth, as prescribed for the patient on order of a physician, at a dose level not to exceed minimal sedation, as defined under this chapter; or(B) Delivery of nitrous oxide/oxygen inhalation sedation.(16) Level II services.(A) The administration of tumescent anesthesia;(B) The delivery of tumescent anesthesia in conjunction with the delivery of narcotic analgesics or anxiolytics by mouth in dosages as defined under Level I, as prescribed for the patient on order of a physician; or(C) Except for the performance of Mohs micrographic surgery, the administration of local anesthesia, peripheral nerve blocks, or both in a total dosage amount that exceeds 50 percent of the recommended maximum safe dosage per outpatient visit.(17) Level III services-- Intravenous, intramuscular, mucosal, rectal or inhalational delivery of narcotic analgesics, anxiolytics, or hypnotics to achieve moderate sedation, as defined under this Chapter. Level III services do not include deep sedation or general anesthesia.(18) Level IV services--The use of regional or neuraxial anesthesia and/or the use of anxiolytics, narcotic analgesics, and/or hypnotics to establish deep sedation or general anesthesia, as defined under this Chapter.(19) Local anesthetics--Dangerous drugs administered topically or by injection, which interrupt nerve conduction, temporarily creating a loss of sensation to an affected area.(20) Minimal sedation--a drug-induced state during which patients respond appropriately to verbal commands. Although cognitive function and physical coordination may be impaired, airway reflexes, and ventilatory and cardiovascular functions are unaffected.(21) Moderate sedation--a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.(22) Narcotic analgesics--Opioid or opioid-like dangerous or scheduled drugs that alleviate pain, but not including non-opioid based drugs such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs).(23) Neuraxial anesthesia--the administration of dangerous drugs or controlled substances into the subarachnoid space or epidural space to produce anesthesia and analgesia. This includes spinal, epidural and caudal anesthesia.(24) Outpatient setting--Any facility, clinic, center, office, or other setting that is not a part of a licensed hospital or a licensed ambulatory surgical center with the exception of the following:(A) a clinic located on land recognized as tribal land by the federal government and maintained or operated by a federally recognized Indian tribe or tribal organization as listed by the United States secretary of the interior under 25 U.S.C. §479-1 or as listed under a successor federal statute or regulation;(B) a facility maintained or operated by a state or governmental entity;(C) a clinic directly maintained or operated by the United States or by any of its departments, officers, or agencies; and(D) an outpatient setting where the facility itself is accredited by either The Joint Commission relating to ambulatory surgical centers, the American Association for Accreditation of Ambulatory Surgery Facilities, or the Accreditation Association for Ambulatory Health Care.(25) PALS--Pediatric Advanced Life Support, as defined by the AHA.(26) PeRLS--Perioperative Resuscitation and Life Support Certificate, as defined by the ASA(27) Regional anesthesia--The injection of local anesthetics into an area of the body directly adjacent to a peripheral nerve, for the purpose of blocking the response to pain in the distribution of sensation of that nerve.(28) Scheduled drugs--Medications defined by the Texas Controlled Substances Act, Chapter 481, Texas Health and Safety Code.(29) Tumescent anesthesia--A specialized type of subcutaneous infiltration of a dilute mixture of local anesthetic and epinephrine known as tumescent solution.