Introduction: Pediatric anesthesia presents unique challenges, necessitating meticulous perioperative sedation strategies for safety and patient comfort. This randomized controlled trial (RCT) explores the optimization of these strategies in 300 pediatric patients (ages 2-12) undergoing elective surgery. We compare three sedation approaches: Group A (standard sedation), Group B (titrated sedation), and Group C (minimal sedation). Methods: Patients were randomized and monitored for adverse events, pain scores, and emergence times. Safety and efficacy were assessed, with primary outcomes being the incidence of adverse events, patient comfort, and satisfaction. Results: Titrated sedation (Group B) demonstrated significantly lower adverse event rates (respiratory depression and airway obstruction) compared to Group A and C. Intraoperative pain scores were significantly lower in Group B, while emergence times were shorter. Patient satisfaction scores were highest in Group B. Conclusion: This RCT supports the adoption of titrated sedation to optimize pediatric perioperative sedation strategies, enhancing safety, comfort, and overall patient satisfaction. Further research is needed to validate these findings across diverse patient populations.