Since January 2014, the American Association of Oral and Maxillofacial Surgeons has required capnography monitoring for all patients under moderate sedation, deep sedation, and general anesthesia in office-based settings. Here's what you need to know about compliance.

What Exactly Does AAOMS Require?

The AAOMS Board of Trustees approved the capnography requirement in March 2012, with enforcement beginning January 2014. This mandate applies to every AAOMS member and is enforced through the periodic Office Anesthesia Evaluation process.

In practical terms, this means every OMS practice performing sedation must have a capnography monitor and must use ETCO2 nasal sampling cannulas (or equivalent sampling devices) on every sedated patient.

Why Was Capnography Mandated?

The AAOMS decision followed the American Society of Anesthesiologists, which mandated capnography for procedural sedation in 2011. The clinical rationale is straightforward: pulse oximetry alone detects oxygen desaturation after it has already occurred, while capnography provides real-time feedback on ventilation that allows clinicians to intervene before hypoxia develops.

ETCO2 monitoring detects respiratory depression, airway obstruction, apnea, and changes in breathing patterns minutes before pulse oximetry would register a problem. For office-based oral surgery where patients are often sedated in a dental chair without an intubated airway, this early warning capability is critical.

What Equipment Does Your Practice Need?

Capnography compliance requires two components:

Understanding the Cost Impact

The Office Anesthesia Evaluation

AAOMS members undergo periodic office inspections that verify compliance with all anesthesia standards, including capnography. Evaluators check for:

• Presence of functioning capnography equipment
• Documentation that capnography is used during sedation cases
• Staff training (DAANCE certification) including capnography competency
• Equipment maintenance and calibration records
• Emergency drug and equipment readiness

Failure to pass the evaluation can result in loss of anesthesia privileges and AAOMS membership implications. This is not a suggestion - it is an enforced standard.

Who Else Requires Capnography?

The AAOMS mandate aligns with broader industry standards:

• ASA requires capnography for moderate and deep sedation
• ADA revised guidelines to require CO2 monitoring for moderate-to-deep sedation
• Multiple state dental boards have adopted capnography requirements independently

The trend is toward universal adoption across all procedural sedation settings.

Keeping Capnography Costs Manageable

The ETCO2 monitor is a one-time capital expense. The ongoing cost is the disposable cannulas - and this is where most practices overpay significantly.

Endure Industries manufactures ETCO2 nasal sampling cannulas that are compatible with all standard sidestream monitors and sell for $1.38 per unit in case quantities (cases of 40 for $55). This represents savings of 50% or more compared to Salter Labs, Teleflex, and McKesson equivalents.

For a practice using 10 cannulas per day, switching to Endure saves approximately $100–$200 per week - over $5,000 to $10,000 per year - without changing any clinical workflow.