Copyright © 2017 International Anesthesia Research Society. Unauthorized reproduction of this article is prohibited. XXX 2017 • Volume XXX • Number XXX www.anesthesia-analgesia.org 1 P revious randomized studies have shown that com- pared with midazolam and fentanyl (MF), propofol expeditiously induces deeper sedation, with faster and more predictable patient recovery. 1 This can result in higher procedural success rates, better patient and endos- copist satisfaction, and increased practice operational eff- ciencies. In North America, the vast majority of propofol sedation is administered by anesthesia professionals, and there has been a marked increase in the prevalence of pro- pofol use for routine outpatient endoscopic procedures in low-risk patients, leading to signifcant increases in costs. 2–4 Studies have suggested that anesthesia-administered pro- pofol sedation may not necessarily be safer than nonanes- thesiologist-administered nonpropofol sedation. 5–7 Because of these considerations, there have been attempts to investi- gate nurse-administered propofol sedation (NAPS). Studies from various countries have suggested that NAPS may be feasible and safe. 8–10 However, currently, NAPS is rarely used in the United States. 11 The development of computer-assisted propofol seda- tion (CAPS) may address many of the safety and regula- tory concerns that serve as obstacles to the use of NAPS. CAPS was approved by the Food and Drug Administration (FDA) in 2013 for moderate sedation in American Society of Anesthesiologists (ASA) class I and II patients under- going routine esophagogastroduodenoscopy (EGD) and colonoscopy. Although both CAPS and NAPS involve Copyright © 2017 International Anesthesia Research Society DOI: 10.1213/ANE.0000000000001898 BACKGROUND: Computer-assisted propofol sedation (CAPS) is now approved for moderate sedation of American Society of Anesthesiologists (ASA) class I and II patients undergoing routine endoscopy. As the frst US medical center to adopt CAPS for routine clinical use, we compared patient and endoscopist satisfaction with CAPS versus midazolam and fentanyl (MF) sedation. METHODS: Patients who underwent elective outpatient upper endoscopy and colonoscopy with CAPS were compared with concurrent patients sedated with MF. The primary end points were patient satisfaction (measured by the validated Patient Sedation Satisfaction Index [PSSI]), and endoscopist satisfaction (Clinician Sedation Satisfaction Index [CSSI]). Secondary end points included procedural success rates, polyp detection rates, adverse events, and procedure/recov- ery times. Multivariable regression was used for comparative analysis. RESULTS: CAPS was utilized to sedate 244 patients, of whom 55 underwent upper endoscopy, 173 colonoscopy, and 16 double procedures. During the same period, 75 upper endoscopies, 223 colonoscopies, and 30 doubles were performed with MF on similar patients. For upper endoscopy, the procedural success rate was 98.2% for CAPS versus 98.7% for MF (P = .96), whereas for colonoscopy, the success rate was 98.9% versus 98.8% (P = .59). Colonoscopic polyp detection rate was 54.5% for CAPS and 59.3% for MF (P = .67). Procedure times were similar between CAPS and MF. For CAPS, the mean recovery time was 26.4 versus 39.1 minutes for MF (P < .001). One CAPS patient required mask ventilation, 4 experienced asymptomatic hypotension or desaturation, and 5 experienced marked agitation resulting from underseda- tion. For MF, 5 patients had hypotension or desaturation, and 8 experienced undersedation. For colonoscopy, the CAPS group had higher PSSI scores for sedation adequacy, the recovery process and global satisfaction, and higher CSSI scores for ease of sedation administration, the recovery process and global satisfaction. For upper endoscopy and doubles, the CAPS CSSI score was higher for the recovery process only. All P values were adjusted for confounding by using regression analysis. CONCLUSIONS: In low-risk patients, CAPS appears to be effective and effcient. CAPS is associ- ated with higher satisfaction than MF for colonoscopies and, to a lesser extent, upper endosco- pies. (Anesth Analg 2017;XXX:00–00) From the *Digestive Disease Institute, Virginia Mason Medical Center, Se- attle, Washington; and †Department of Anesthesia, Virginia Mason Medical Center, Seattle, Washington. Accepted for publication December 14, 2016. Funding: None. Conficts of Interest: See Disclosures at the end of the article. Reprints will not be available from the authors. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.anesthesia-analgesia.org). Address correspondence to Otto Lin, MD, Virginia Mason Medical Center, 1100 Ninth Ave, Seattle, WA 98101. Address e-mail to Otto.Lin@vmmc.org. The First US Clinical Experience With Computer-Assisted Propofol Sedation: A Retrospective Observational Comparative Study on Efficacy, Safety, Efficiency, and Endoscopist and Patient Satisfaction Otto S. Lin, MD, MSc,* Richard A. Kozarek, MD,* Deborah Tombs, BSN, RN,* Danielle La Selva, BA,* Wade Weigel, MD,† Ryan Beecher, CRNA, MSN,† Ana Jensen, MD,* Michael Gluck, MD,* and Andrew Ross, MD*