Patient-controlled sedation (PCS) offers patients greater control over sedation during procedures where general anaesthesia is unnecessary. This scoping review explores current evidence on PCS in adult medical and surgical procedures, focusing on usage, satisfaction, safety and economic potential.
Methods
A comprehensive database search was done and screening was conducted using a web-based tool. Two independent reviewers assessed eligibility based on participant characteristics and PCS assessment. The review addressed: 1) Procedures where PCS is used, 2) Sedative agents employed, 3) Patient characteristics, 4) Patient and operator experiences, 5) Economic implications and 6) Side effects of PCS.
Results
A total of 6665 patients from 110 studies were analysed. The most common procedures were dental procedures (n = 26) and colonoscopies (n = 17). Propofol (n = 79) and midazolam (n = 31) were the most frequently used agents. Most patients were under 70 years and had ASA scores of 1–2; however, 31 studies included ASA three patients. High patient satisfaction was consistently reported across studies, regardless of the sedative used. Three studies indicated potential economic benefits, suggesting lower costs compared to healthcare-administered sedation. Patient-controlled sedation demonstrated a favourable safety profile, with minimal severe adverse events and manageable side effects.
Conclusion
Patient-controlled sedation is widely studied in medical and dental procedures, predominantly using propofol or midazolam in ASA 1–2 patients under 70 years. It offers high patient satisfaction, favourable safety and promising economic advantages.
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