Updated Anesthesia Class Requirements

Several clarifications were added (shown in red in the document) to help facilities understand what’s allowed within each anesthesia class—especially around nitrous oxide, oral medications that can cause sedation, and when a technique or medication combination moves a case into a higher class. Below is a plain-language summary of what changed and what to double-check in your day-to-day workflows.

At a glance: The updates don’t introduce new facility classes—they sharpen the guardrails so facilities can more consistently match their cases, medications, and anesthesia techniques to the appropriate facility class.

Class A: Clearer boundaries for minimal sedation and technique selection

The Class A section includes multiple redline clarifications that reinforce a narrow scope: local/topical anesthesia, minimal sedation via oral medications, or nitrous oxide delivered via a standalone system—without drifting into moderate sedation or higher-risk technique combinations. 

• Nitrous oxide must use a standalone delivery system: The wording emphasizes nitrous oxide administration using a standalone delivery system.
• No moderate sedation in Class A: The clarification explicitly states that accreditation under facility Class A standards is not permitted using moderate sedation.
• Limit oral sedating medications to one (1) class perioperatively: To avoid exceeding minimal sedation, the patient may receive only one class of oral medication that can cause sedation (examples listed include: opioid analgesics, anxiolytics, ketamine HCl, hypnotics, and antihistamines). Pre-arrival doses prescribed by the surgeon count toward this limit. The patient may receive a second dose of the same oral medication (class) anytime during the perioperative phase as long as it does not cause the patient to exceed a minimal sedation state.
• Practical example added: If diazepam is administered, the facility may not administer any other sedating drug besides diazepam, and any subsequent doses must not impair normal response to verbal stimulation. The example also clarifies that acetaminophen may be given because it does not cause sedation.
• Combination restriction clarified: Nitrous oxide combined with any agent that results in minimal sedation is not permitted in a Class A facility; that combination is only permitted in higher facility classes.
• Technique alignment language tightened: Redline edits reinforce that certain practices (e.g., cases involving oral anxiolytics such as diazepam in conjunction with major peripheral/plexus blocks or advanced regional techniques) fall under the Class B standard, and Class A prohibits regional/field blocks beyond simple local infiltration—while explicitly noting an exception allowing simple local infiltration, including digital nerve blocks.

Class B: Terminology and moderation—what “moderate” means here

The Class B description adds redline language that helps interpret intent and definitions. In particular, it calls out that intravenous sedation and related modalities are expected to result in moderate sedation, and it clarifies that “conscious sedation” is a former label for this level. This is helpful when mapping internal policies, staff training, and case selection criteria to the facility class definitions.

• Moderate sedation language clarified: Class B cases are described as resulting in moderate sedation, with a parenthetical noting it was formerly referred to as conscious sedation.

Class C: International pathway wording and cross-class requirements

Redline edits in the later classes primarily refine how an international facility relates to Class C and Class C-M, and clarify conditions tied to equipment expectations (e.g., when inhalational anesthetics are not present) and international facility compliance expectations.

• TIVA clarification: The clarification notes that facilities using total intravenous anesthesia (TIVA) and having no inhalational anesthetics present would not be required to have an anesthesia machine (with a reference to another standard in the source document).
• International facilities note reinforced: A redline clarification highlights that international facilities pursuing accreditation under facility Class C standards must comply with all facility Class C standards—including general anesthesia with an anesthesia machine—in addition to all requirements for facility Classes A, B, and C-M.

What facilities should do now?
 Use this checklist to turn the redline clarifications into practical steps. These are common places where well-intended practice can accidentally drift into a higher anesthesia class.

• Confirm your nitrous oxide setup: Ensure nitrous oxide is administered using a standalone delivery system with required safety features, and that staff know what that means in your setting.
• Re-check “minimal sedation” medication pathways in Class A: Build a simple process to verify the patient is receiving only one class of oral medication that can cause sedation perioperatively (including any dose taken before arrival if prescribed for the procedure).
• Avoid Class A “stacking” that pushes cases into Class B: If a patient receives more than one class of oral medication that can cause sedation, you are no longer practicing under Class A requirements and are out of compliance. If this is routine practice, contact your Accreditation Specialist and discuss options for upgrading to Class B or determine internally how to keep sedation within Class A requirements.
• Match regional techniques to the right class: If your practice includes major peripheral/plexus blocks or advanced regional techniques alongside oral anxiolytics, ensure that you are accredited under Class B (or higher) standards. If you are Class A, confirm staff understands the exception for simple local infiltration (including digital nerve blocks).
• If you are an international facility: When pursuing accreditation under facility Class C standards, plan for full compliance with Class C standards—including general anesthesia with an anesthesia machine—alongside all A, B, and C-M requirements.
  

 If you’d like help translating these clarifications into a facility-specific workflow (who can administer what, which combinations are allowed, and what equipment/training is needed), consider doing a quick crosswalk of your most common cases against the class definitions and documenting the “go/no-go” decision points.

 The updated Anesthesia Class Requirements Document can be found HERE.

Questions 

Thank you for your continued dedication to safety and excellence. If you have any questions or require further clarification, please email standards@quada.org.

Since 1980, QUAD A (a non-profit, physician-founded and led global accreditation organization) has worked with thousands of healthcare facilities to standardize and improve the quality of healthcare they provide – believing that patient safety should always come first.