Fiberoptic bronchoscopy should be performed in a safe, efficient, and reasonably comfortable manner. Maximal comfort can be obtained in the operating theater using general anesthesia. This sacrifices efficiency, increases cost, and exposes the patient to the risks of general anesthesia. Bronchoscopy also can be performed solely with local anesthesia. Obviously, this does not optimally alleviate pain and anxiety. If the patient’s cough and pain are not controlled, the yield of the procedure can decrease. The use of IV sedation and analgesia (conscious or moderate sedation) provides a middle ground between these two approaches. It is a compromise between general anesthesia and a “bite-the-bullet” approach. The goal of moderate sedation is to achieve a proper balance among comfort, efficiency, cost, efficacy, and safety.