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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.

We examined the structural validity, internal consistency (alpha and omega), and test-retest reliability of scores on the Cross Racial Identity Scale (CRIS; Vandiver et al., 2000 ; Worrell, Vandiver, & Cross, 2004 ), as well as the relationship between CRIS scores and several variables related to psychological adjustment. Participants consisted of several groups of African American college students (34 ≤ n ≤ 340) attending a predominantly White university in a Western state. Confirmatory factor analyses indicated an acceptable fit of the data to the theoretical model, and alpha and omega coefficients indicate that CRIS scores have moderate to high internal consistency. CRIS scores also demonstrated stability over periods between 2 and 20 months in ranges that suggest long-term stability of racial attitudes. As predicted by the expanded nigrescence model (Cross & Vandiver, 2001 ), only self-hatred attitudes had consistent, meaningful relationships with psychological adjustment.

Background: The SEDASYS System is an investigational computer-assisted personalized sedation system integrating propofol delivery with patient monitoring to enable endoscopist/nurse teams to safely administer propofol., Objective: To compare the safety and effectiveness of the SEDASYS System to the current standard of care for sedation during routine endoscopic procedures., Design: Nonblinded multicenter randomized comparative study., Setting: Four ambulatory surgery centers, 3 endoscopy centers, and 1 academic center in the United States., Patients: One thousand American Society of Anesthesiologists physical status class I to III adults undergoing routine colonoscopy or EGD., Interventions: Sedation with the SEDASYS System (SED) and sedation with each site's current standard of care (CSC; benzodiazepine/opioid combination)., Main Outcome Measurements: Area under the curve of oxygen desaturation was the primary endpoint. Secondary endpoints included patient satisfaction, clinician satisfaction, level of sedation, and patient recovery time., Results: Four hundred ninety-six patients were randomized to SED and 504 to CSC. Area under the curve of oxygen desaturation was significantly lower for SED (23.6 s·%) than for CSC (88.0 s·%; P = .028). Patients were predominately minimally to moderately sedated in both groups. SED patients were significantly more satisfied than CSC patients (P = .007). Clinician satisfaction was greater with SED than with CSC (P < .001). SED patients recovered faster than CSC patients (P < .001). The incidence of adverse events was 5.8% in the SED group and 8.7% in the CSC group., Limitations: Nonblinded., Conclusions: The SEDASYS System could provide endoscopist/nurse teams a safe and effective on-label means to administer propofol to effect minimal to moderate sedation during routine colonoscopy and EGD., (Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.)

Background: Demand for colonoscopy and EGD procedures is increasing. Impediments to performing these examinations persist. Patients perceive these procedures as unpleasant and painful. The use of suboptimal sedatives results in inefficiency in endoscopy practices. Improving sedation methods utilizing precise control of preferred sedatives may increase patient satisfaction and practice efficiency., Objective: Our purpose was to demonstrate the feasibility of computer-assisted personalized sedation (CAPS) for facilitating the precise administration of propofol by endoscopist/nurse teams, achieving minimal to moderate sedation in subjects undergoing routine endoscopies., Design: Open label, single-center studies., Setting: Endoscopy clinics in Charlottesville, Virginia, and Gent, Belgium., Subjects: Twenty-four adults per center; 12 colonoscopies, 12 EGDs., Interventions: Propofol sedation with CAPS by endoscopist/registered nurse care teams., Main Outcome Measurements: Sedation level measured by modified observer's assessment of alertness/sedation (MOAA/S), recovery time measured from endoscope removal until Aldrete >/= 12, dosage of propofol, oxygen saturation, and safety assessments., Results: Subjects responded to mild tactile and verbal stimuli MOAA/S = 5, 4, 3, or 2) 99% of the time. Mean propofol doses in the United States and Belgium were 65.4 and 72.1 mg, respectively. Mean recovery times were 29 and 10 seconds, respectively. Oxygen desaturation occurred in only 6% of subjects. No device-related adverse events occurred., Limitation: Open-label design., Conclusions: Using CAPS, the endoscopist/nurse teams precisely controlled the administration of propofol achieving minimal to moderate sedation in subjects undergoing colonoscopy and EGD procedures. Mean propofol dosage was low and post-procedure recovery times were rapid. The device performed well when operated by the endoscopist/nurse team, with no device-related adverse events.

The Superfund Innovative Technology Evaluation (SITE) Program is now in its sixth year of demonstrating technologies applicable to Superfund sites. The SITE Program, conducted by the U.S. Environmental Protection Agency's Risk Reduction Engineering Laboratory, is intended to accelerate the use of new and innovative treatment processes as well as evaluate innovative measurement and monitoring techniques. Within the SITE Program, the Demonstration Program and the Emerging Technologies Program are responsible for innovative/alternative waste treatment technology development. Separate and parallel activities are progressing for development and evaluation of measuring and monitoring technologies as well as technology transfer operations.