title: Use of computer-assisted drug therapy outside the operating room.
abstract: OBJECTIVE
  The number of procedures performed in the out-of-operating room setting under sedation has increased many fold in recent years. Sedation techniques aim to achieve rapid patient turnover through the use of short-acting drugs with minimal residual side-effects (mainly propofol and opioids). Even for common procedures, the practice of sedation delivery varies widely among providers. Computer-based sedation models have the potential to assist sedation providers and offer a more consistent and safer sedation experience for patients.
  
  
  RESULTS
  Target-controlled infusions using propofol and other short-acting opioids for sedation have shown promising results in terms of increasing patient safety and allowing for more rapid wake-up times. Target-controlled infusion systems with real-time patient monitoring can titrate drug doses automatically to maintain optimal depth of sedation. The best recent example of this is the propofol-based Sedasys sedation system. Sedasys redefined individualized sedation by the addition of an automated clinical parameter that monitors depth of sedation. However, because of poor adoption and cost issues, it has been recently withdrawn by the manufacturer.
  
  
  CONCLUSIONS
  Present automated drug delivery systems can assist in the provision of sedation for out-of-operating room procedures but cannot substitute for anesthesia providers. Use of the available technology has the potential to improve patient outcomes, decrease provider workload, and have a long-term economic impact on anesthesia care delivery outside of the operating room.
authors.affiliation: aDepartment of Anesthesia, All India Institute of Medical Sciences, New Delhi, India bDepartment of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Preet Mohinder
authors.initials: PM
authors.lastname: Singh
authors.forename: Anuradha
authors.initials: A
authors.lastname: Borle
authors.forename: Basavana G
authors.initials: BG
authors.lastname: Goudra
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000493:pharmacokinetics; D001049:Apnea / Q000139:chemically induced / Q000517:prevention & control; D000066491:Clinical Decision-Making; D016292:Procedural Sedation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D054810:Deep Sedation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004360:Drug Therapy, Computer-Assisted / Q000379:methods / Q000706:statistics & numerical data*; D004724:Endoscopy / Q000009:adverse effects; D005246:Feedback; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000494:pharmacology; D007262:Infusions, Intravenous / Q000295:instrumentation / Q000379:methods; D008991:Monitoring, Physiologic; D059408:Pain Management / Q000295:instrumentation / Q000379:methods; D000073818:Procedural Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D057285:Precision Medicine / Q000295:instrumentation / Q000379:methods
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives