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Sedation can resolve anxiety and fear in patients undergoing endoscopy. The use of sedatives has increased in Korea. Appropriatesedation is a state in which the patient feels subjectively comfortable while maintaining the airway reflex for stable spontaneousbreathing. The patient should maintain a state of consciousness to the extent that he or she can cooperate with the needs of themedical staff. Despite its benefits, endoscopic sedation has been associated with cardiopulmonary complications. Cardiopulmonarycomplications are usually temporary. Most patients recover without sequelae. However, they may progress to serious complications,such as cardiovascular collapse. Therefore, it is essential to screen high-risk patients before sedation and reduce complications bymeticulous monitoring. Additionally, physicians should be familiar with the management of emergencies. The first Korean clinicalpractice guideline for endoscopic sedation was developed based on previous worldwide guidelines for endoscopic sedation using anadaptation process. The guideline consists of nine recommendations based on a critical review of currently available data and expertconsensus when the guideline was drafted. These guidelines should provide clinicians, nurses, medical school students, and policymakers with information on how to perform endoscopic sedation with minimal risk.