In the late 1990’s, as pediatric MRI imaging services came of age, pediatric hospitals were faced with a growing need for quality pediatric sedation services. Many institutions met this need initially by assembling experienced nurses and having them manage the sedations. By the early 2000’s, the nurse-run services were being replaced by physician services, as the Joint Commission developed new standards for deep sedation services. In compliance with Joint Commission standards, both Children’s campuses Scottish Rite and Egleston developed physician run sedation services. Pediatric Sedation Services (PSS) was developed on the Scottish Rite campus by the PEMA physician group, and Children’s Sedation Services (CSS) was formed as a combined effort by the critical care and pediatric emergency medicine teams at the Egleston campus. Both PSS and CSS have grown in volume and scope of services and, as a system, represent one of the largest pediatric procedural sedation services, performing over 11,000 cases per year.