Emergency preparedness is the key to preventing and managing emergent situations during moderate sedation. The doctor and staff must be adequately trained and adept at monitoring, airway management, and emergency treatment protocols. An office emergency manual should be developed and maintained, practice emergency drills should be scheduled regularly, and current continuing education in emergency management must be kept current. As patients age, medical complexity increases and the potential for perioperative emergencies is enhanced. Moderate sedation provides a means to mitigate untoward cardiovascular stress and is indicated as medical complexity increases. This chapter reviews potential situations that require intraoperative intervention and management, including airway and respiratory compromise, and changes in cardiovascular parameters.