With the expansion of Transcatheter Aortic Valve Implantation (TAVI) to intermediate risk patients, anesthesiologists will encounter more and more of these procedures. The trend from general anesthesia to sedation is a worldwide trend but highly depends on the experience of the surgeons and cardiologists. In more experienced hands, sedation technique is feasible. The need for transesophageal echocardiography (TEE) is not necessary because the results using fluoroscopy alone is comparable to that of TEE guidance. Hypercapnia is a big drawback of sedation, sometimes severe enough to cause narcosis or even hypoxemia. The effects could be detrimental to patients with preexisting pulmonary hypertension. While it is a general trend, anesthesiologists must be prepared to face catastrophes and prepare the tools for intubation as a final line of defense.