The demands made on a modern emergency department (ED) are such that having an internal capacity to provide a range of procedural sedation is essential to its functioning. Emergency physicians (EPs) have advanced airway management and resuscitation training to manage complications arising from sedation. A good working relationship between the department of anesthesia and the ED is thus of great importance in creating and maintaining a procedural sedation program. Both moderate and deep sedation have been shown to be safe tools in the hands of EP. Striking a balance between safety and prompt treatment is a prime consideration for the EP. The drug and dose should be primarily chosen as a function of the sedation assessment. For many ED sedations, propofol is chosen for its effects and short duration of action. The chapter also presents a few representative cases describing procedural sedation management of patients in the ED setting.