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The rise, fall, and future direction of computer-assisted personalized sedation

Martin, James F.a; Niklewski, Paul J.a,b; White, Jeffrey D.c

Current Opinion in Anesthesiology: August 2019 - Volume 32 - Issue 4 - p 480–487
doi: 10.1097/ACO.0000000000000761
DRUGS IN ANESTHESIA: Edited by Ken B. Johnson

Purpose of review The first computer-assisted personalized sedation (CAPS) device was developed to address the growing demand for routine endoscopy procedures in the United States in the early 2000s. This review will describe the environment that gave rise to CAPS and summarize the design of that first device. It will then discuss the market forces that led to the fall of CAPS, with sales of the device ending 2 years after commercialization.

Recent findings CAPS was initially conceived as a means to enable proceduralists to administer conscious sedation with propofol safely. In the nearly 20 years since its conception, the expectations of patients and proceduralists for endoscopy sedation, have evolved from conscious sedation to deep. Due to the increased risk inherent in deep sedation, future CAPS devices should be tools for anesthesiologists, not proceduralists.

Summary Over $2 billion are spent annually for anesthesia services in routine endoscopic procedures for low-risk patients; a spending rate that is not sustainable. CAPS, in an ‘anesthesia oversight’ model similar to medical supervision, has a future as a cost-efficient means for anesthesia services to provide sedation in endoscopy and other nonoperating room venues. Anesthesiologists should work with medical device companies and payers to develop a CAPS ‘anesthesia oversight’ model.

aMDP-Solutions, LLC

bDepartment of Pharmacology and Systems Physiology, College of Medicine, University of Cincinnati, Cincinnati, Ohio

cDepartment of Anesthesiology, University of Florida, Gainesville, Florida, USA

Correspondence to Paul J. Niklewski, PhD, CARE/Crawley Building, Suite E-870 3230, Eden Avenue, Cincinnati, OH 45267, USA. Tel: +1 513 558 7333; e-mail:

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