Resuming procedural sedation services for elective procedures during the COVID-19 pandemic requires unique considerations to ensure safety for patients and providers. Guidelines for resuming these procedures, including timing, screening and testing, use of personal protective equipment, and case planning are discussed. Approaches to procedural sedation can be modified to reduce the risk of droplet or aerosol transmission by decreasing nasal cannula oxygen supplementation flows. Decreasing the need for oxygen supplement can be accomplished by opioid and sedative sparing strategies, including the use of multimodal analgesia and non-pharmacologic analgesic and anxiolytic interventions. Recommendations are made for patients who are COVID-19 positive and require procedural sedation.