Emergency Department care of children for illness or injury is unscheduled, distressing, and often involves diagnostic or therapeutic procedures that may be painful and may require patient immobilization. Management of procedure-related pain and anxiety, while maintaining patient safety, is essential for successful procedure completion and for minimizing untoward psychological consequences. Procedural sedation and analgesia involve strategies and techniques to extend compassion and attenuate anxiety and pain while ensuring patient safety and facilitating procedural success. Preprocedural assessment of patient risk and appropriateness for sedation, careful pharmacologic regimen planning suitable to procedure and patient, preparation of adjuncts and rescue equipment, direct observation and physiologic monitoring of patient response to sedative/analgesic administration throughout the procedure until recovery, adverse event recognition and capability to rescue the patient from sedation-related adverse effect, and recovery of the patient to baseline status are all essential elements of sedation care in the emergency department addressed in this chapter.