John J. Vargo, MD, MPH, AGAF, FACP, FACG, FASGE, Editor

There is a time for many words, and there is also a time for sleep.

The following collection of articles provides a primer for the practitioner and trainee alike in addressing training and competency in sedation practice, the preprocedural assessment of the patient, the role of quality assurance in procedural sedation, how to achieve an important balance between safety and throughput in the endoscopy suite as well as an important discussion on risk management. The use of nonoperative remote anesthesia is discussed by a group of anesthesiologists who pioneered the role in the endoscopy suite many years ago and remain among the thought-leaders in their specialty. In addition, the role of procedural sedation in specialized populations such as children and in those with obesity and sleep apnea is addressed. We also look beyond pulse oximetry to extended monitoring technologies, such as capnography, and critically appraise their value. We review the role of computer-assisted sedation and revisit endoscopist-directed propofol sedation: will it ever regain its former foothold? Finally, we gaze into a crystal ball in an attempt to determine what procedural sedation for gastrointestinal endoscopy may look like in the future.

I am honored and humbled to have been given the privilege to edit this work. I would like to thank Dr Charlie Lightdale for the opportunity. His career of clinical care and research was a beacon to me as junior fellow and remains as such many years later. I would also like to thank the group of world-class authors who contributed to this issue. In closing, I would also like to remind our readers that complacency should never be in a clinician’s lexicon. We all garner a sacred and unwavering responsibility to build upon our current practice of procedural sedation to make it more effective and safer in this evolving value-based practice environment.