Sedation impacts every aspect of endoscopy practice--the quality fo the examination, the satisfaction of endoscopist and of patient, the efficiency and cost of delivering services, and the compliance of patients with surveillance guidelines. New sedation agents and improved patient-monitoring and drug-delivery technologies are challenging traditional practices. Increasing demand for endoscopic services, shrinking reimbursements, and competing diagnostic technologies are prompting recognition that new approaches to sedation can improve practice efficiency and patient outcome. This article discusses new developments in endoscopic sedation and their implications for practice management.