Sedation and analgesia are required on a daily basis for infants and children in the pediatric intensive care unit (PICU). Regardless of the patient’s age, cognitive level, underlying medical condition, or comorbid conditions, various factors may result in agitation, anxiety, and pain during their PICU experience. One of the challenges of the PICU is the variability in patient age, weight, comorbid conditions, and acute illness. Procedure type and duration, as well as patient location (in the PICU versus off-site), must also be considered. The primary goals are to provide analgesia, anxiolysis, and comfort while promoting early mobility, sleep hygiene and preventing delirium. Due to their expertise in early recognition and management of airway and hemodynamic compromise, pediatric intensivists provide procedural sedation outside of the PICU.