Gastrointestinal (GI) endoscopic procedures have become integral to both diagnostic and therapeutic interventions, with increasing complexity requiring advanced perioperative anesthetic management. This review explores contemporary anesthetic approaches and risk mitigation strategies tailored to the diverse range of GI endoscopic procedures, including esophagogastroduodenoscopy (EGD), colonoscopy, endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasound (EUS). Special attention is given to airway management, sedation techniques, patient positioning, and the management of procedure-specific risks such as aspiration, hypoxia, and cardiovascular instability. The review also addresses considerations in high-risk populations, including the elderly, patients with obstructive sleep apnea, and those with significant cardiopulmonary comorbidities. Emphasis is placed on multidisciplinary planning, individualized sedation plans, and the use of capnography and other monitoring tools to enhance safety and improve outcomes.