In the new millennium, there has been a huge surge in the numbers of procedures performed under sedation in pediatric patients outside the operating room. Traditionally, these were performed by anesthesiologists. Increasingly, other specialists, such as emergency room physicians, pediatricians and radiologists, are involved in the management of procedural sedations under elective or emergency situations. Professional organizations such as the American Society of Anesthesiologists, American Academy of Pediatrics, Joint Commission on Accreditation of Healthcare Organizations and other organizations are working continuously to make procedural sedation for children safe, economical and tailored to the needs of the child and the diagnostic/therapeutic procedure being performed. Multi-institutional databases have been set up to investigate the complications related to procedural sedation and lessons are being learned from the analysis of these data. This article reviews these data and describes strategies to prevent and manage common adverse events following procedural sedation in children outside the operating room.