Procedural sedation refers to techniques, medications, and maneuvers used to help patients tolerate unpleasant or painful procedures and avoid unwanted procedure-associated adverse memories. The patient’s history of chronic cardiovascular disease, respiratory disease, and medication use, as well as their allergies and stability, affect the risk of harm during sedation and procedures. It is essential to assess the risk of complications, with the American Society of Anesthesiologists Physical Status Classification System the most commonly used clinical assessment system. Managing sedation and surgery aims to assess disease severity, confirm the patient is in optimal condition before surgery (there is a difference in eligibility between emergency and elective surgery), and individualize premedication for each patient. The premedication drugs should be carefully dosed to optimize sedation and perioperative management using methods and drugs with minimal impact on comorbidities. The most serious complication is respiratory failure due to airway obstruction or hypoventilation, which can trigger or exacerbate cardiovascular symptoms, leading to cardiovascular failure, and is particularly important in patients with a history of ischemic heart disease, myocardial infarction, cardiomyopathy, valvular defects, or cardiac arrhythmias. The New York Heart Association functional classification of heart failure combines survival and quality of life to determine cardiovascular disease severity and complication risk. Maintaining arterial blood oxygenation through adequate ventilation and coronary perfusion pressure by avoiding large fluctuations in blood pressure, especially hypotension under sedation or surgery, and minimizing myocardial oxygen consumption through appropriate sedation and analgesia is always the primary aim when managing myocardial complication risk. Difficulties with mask ventilation should be considered during sedation and procedures in patients with sleep apnea syndrome. As such, these patients require continuous night-time monitoring throughout their hospital stay and after surgery.