Millions of colonoscopies are performed around the world each year. Colonoscopies are associated with discomfort and pain, which can be problematic for the patient as well as the endoscopist. Most screening colonoscopies are performed on an outpatient basis where access to anesthesia providers may be limited. Interventional colonoscopies, retrograde double-balloon enteroscopies, and colonoscopies requiring deep levels of sedation are often performed with the assistance of anesthesia providers. Patients with multiple comorbidities, uncooperative patients, pediatric patients, patients with a history of difficult sedations, and patients with a history of airway related difficulties are best served by the involvement of an anesthesiologist. Sedation and patient care strategies will be reviewed in this chapter. Ultimately, the best anesthetic technique will be determined by patient factors, procedural difficulty, procedural duration, anticipated depth of sedation required, and ability to modify the chosen technique as the situation changes.