A survey of American College of Gastroenterology members published in 2006 showed that 98.8% of colonoscopies utilized intravenous sedation.1 Certainly, the vast majority of patients in the US want to be sedated for colonoscopy, and, in fact, many have the expectation “to be put out” or that at least they will feel no pain or discomfort during the procedure. Questionnaire studies in the US suggest that less than 5% to 20% of patients express even a willingness to consider unsedated colonoscopy. 1-4 However, it is well known that sedation accounts for a substantial proportion of the costs and complications of the procedure.