Recent advances in patient-controlled sedation.
OBJECTIVE
Advances in minimally invasive procedures have resulted in an increased demand for procedural sedation. Patient-controlled sedation (PCS) has been in clinical use for almost 20 years, but has not been reviewed in over 10 years.


RESULTS
Advances in microprocessor technology, increased demand for procedural sedation in a cost-conscious environment, and the availability of readily titratable pharmacologic agents together stimulated the development of alternative sedation practices. Continued research into the neurobiology of pain perception and the placebo effect has also played a role. PCS and patient-maintained sedation, primarily with propofol, have emerged as intriguing clinical alternatives to traditional sedation based in part on extensions of traditional PCA models.


CONCLUSIONS
PCS has been applied to a wide variety of procedures, but systems that can be applied 'off-the-shelf' are not easy to tune. New approaches to PCS may address these limitations. Better understanding of the psychology of sedation may lead to better patient acceptance of PCS.
Atkins
Joshua H
JH
Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania 19103, USA.
Mandel
Jeff E
JE
D016058:Analgesia, Patient-Controlled / Q000379:methods; D016292:Procedural Sedation / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000493:pharmacokinetics; D007260:Infusion Pumps; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D010880:Piperidines / Q000008:administration & dosage* / Q000493:pharmacokinetics; D015742:Propofol / Q000008:administration & dosage* / Q000493:pharmacokinetics; D000077208:Remifentanil
D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol