With the technological advancement in medicine, a paradigm shift has been noted in what can be achieved with the minimally invasive endoscopic procedures with equal, and in some cases superior, outcomes as the conventional modalities due to lower procedure and recovery time and markedly reduced adverse outcomes. Approximately 50 million gastrointestinal endoscopic procedures were performed in 2017. Of these, over 19 million were lower gastrointestinal endoscopies (sigmoidoscopies and colonoscopies) [1, 2], and most of these procedures were performed under varying levels of sedation. The advancement in the endoscopic sedation has been equally tremendous, from the unsedated procedures early on, to over 98% of endoscopies being performed under sedation in the United States, with similar trends elsewhere in the world [3]. The most notable change over the last couple of decades has been the shift from hospital to office-based practices and the slow but growing use of sedatives like propofol by non-anesthesiologists despite the ongoing debate on who the appropriate provider for this administration should be [4]. Even though some procedures can be performed unsedated, it is recommended that sedation should be offered to every patient before endoscopy [5], especially since patient satisfaction, in addition to other factors affected by adequate sedation, is considered a quality indicator of endoscopy [3, 6]. As a result, sedation and analgesia are now an integral part of the practice of gastrointestinal endoscopy.