SCOPE OF THE PROBLEM Procedural sedation and analgesia (PSA) in the emergency department (ED) is a common component of the modern practice of emergency medicine. The concepts inherent to PSA, however, are not new to emergency care for the sick and wounded. Medical accounts from authors as early as Hippocrates have included descriptions of painful procedures, such as orthopedic dislocation and fracture reduction, in their accounts of the stabilization of patients with acute medical and traumatic conditions. Along with these descriptions, physicians have often described the use of certain techniques or adjuncts to assuage the pain associated with therapeutic procedures. Historical depictions of procedure patients have frequently included images of caregivers providing alcohol or inhalational agents to alleviate procedure-related pain and suffering. These concepts have become inherent to our collective view of the role of medical caregivers as both prescribing treatment as well as relief of pain and suffering throughout history. The rationale for administration of analgesic and/or sedative agents has generally relied upon the reduction of pain and suffering. Modern medical practice recognizes the importance of PSA as being equally important for the provision of a number of additional elements including relaxation of affected muscle groups and tissues adjacent to injured structures, reduction of patient anxiety, and as a means to improve the broad experience of the procedure encounter not only for the patient but also for patient family members and health-care providers alike.