(A) A physician performing liposuction in the office setting shall meet the training requirements set forth in paragraph (A) of rule 4731-25-03 of the Administrative Code and must be in compliance with this rule.
(B) Liposuction in the office setting shall be performed in compliance with rules 4731-25-03 and 4731-25-04 of the Administrative Code as appropriate to the level of sedation being administered and in compliance with the following standards:
(1) The cannula utilized shall be no larger than 4.5 millimeters in diameter;
(2) The concentration of lidocaine in the solution shall not be greater than 0.1 per cent and the total dosage of lidocaine received by the patient during the procedure shall not exceed fifty milligrams per kilogram of body weight;
(3) The concentration of epinephrine in the solution shall not be greater than 1.5:1,000,000 and the total dosage of epinephrine received by the patient during the procedure shall not exceed fifty micrograms per kilogram of body weight;
(4) Intravenous access shall be maintained if the total aspirate is less than or equal to one hundred milliliters;
(5) If the total aspirate is more than one hundred milliliters, an intravenous line shall be running at a rate sufficient to prevent hypovolemia and must be monitored appropriately;
(6) Appropriate monitoring shall be performed. Such monitoring shall include:
(a) Recording the baseline vital signs, including blood pressure and heart rate, both preoperatively and postoperatively.
(b) If more than one hundred milliliters of aspirate is to be removed, a second person who is a health care professional as that term is defined in section 2305.234 of the Revised Code and who is acting within that health care professional's scope of practice shall be continuously within the room to monitor the patient. Continuous blood pressure monitoring and cardiac monitoring with pulse oximetry shall be performed and documented; supplemental oxygen shall be available.
(c) Patients who receive oral anxiolytics, sedatives, narcotic analgesics, moderate sedation or anesthesia services shall be monitored postoperatively until fully recovered and ready for discharge.
(7) Liposuction in the office setting shall be performed only on patients who are evaluated as level P1 or P2 according to the version of the American society of anesthesiologists physical status classification system current at the effective date of this rule;
(8) Liposuction shall not be performed in an office setting in combination with other procedures except as specifically authorized in paragraph (F) of this rule.
(C) Liposuction performed in an office setting shall not exceed four thousand five hundred milliliters of total aspirate.
(D) Liposuction using moderate sedation/analgesia or anesthesia services performed in an office shall be accredited in accordance with rule 4731-25-07.
(E) The written discharge instructions given to the patient shall include specific information concerning the symptoms of lidocaine toxicity, the period of time during which such symptoms might appear and specific instructions for the patient to follow should the patient experience such symptoms.
(F) Nothing in this rule shall be interpreted to prohibit a physician from performing in the office setting procedures involving a focused, local small liposuction that is a routine part of the main procedure, provided that the physician complies with all other applicable rules.
(G) A violation of any provision of this rule, as determined by the board, shall constitute "a departure from, or the failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established," as that clause is used in division (B)(6) of section 4731.22 of the Revised Code.