The number of pediatric patients requiring sedation for procedures performed outside the operating room environment continues to grow yearly, as does the number of patients surviving to adulthood with the residua and sequelae of congenital heart disease. Ongoing efforts to develop guidelines to enhance the safety of these pediatric sedative encounters have resulted in great strides in the prevention of adverse events. In addition, the Society for Pediatric Sedation, associated with the Pediatric Sedation Research Consortium, provides an important forum for practitioner education and the promotion of safe care for infants and children undergoing sedative experiences. Care of the subset of patients with congenital heart disease or pulmonary hypertension remains especially demanding. The additional safety challenges posed by remote locations make the highest level of vigilance essential when planning and performing sedation for these children.