Transesophageal echocardiography (TEE) is a minimal invasive diagnostic tool performed for a growing number of patients in echocardiography departments and intensive care units. Such as other semi-invasive procedures, TEE requires some degrees of sedation to achieve better patient safety and comfort and operator convenience. Given the potential minor and rarely major cardio-respiratory complications of TEE, it is essential that a highly skilled person conduct the sedation. Noninvasive blood pressure measurement, ECG, and pulse oximetry are essential monitoring tools, but they cannot replace the clinical examination and observation of the patient thorough the TEE procedure. It’s not uncommon, for patients who are prone to claustrophobia to experience intense anxiety during an MRI scan and procedural sedation can enable them to endure the experience and get the valuable information that MRI can provide. In this chapter, we offer anesthesiologists and non-anesthesiologist providers practical notes regarding sedation during TEE and cardiac magnetic resonance (CMR) imaging to guarantee best patient safety.