A pilot study comparing Dexmedetomidine and Midazolam in sedation for upper endoscopy

Background Upper gastrointestinal endoscopy often causes discomfort and anxiety, requiring effective sedation to ensure patient comfort and procedural safety. This study compared the efficacy and safety of Midazolam and Fentanyl versus Dexmedetomidine and Fentanyl sedation during upper endoscopy, it was conducted as a preliminary investigation to guide the design of a future definitive trial. Methods A prospective pilot study was conducted at An-Najah National University Hospital, Palestine, from October 2021 to January 2022. Sixty-eight ASA I and II outpatients aged 18–60 years were assigned to receive either Dexmedetomidine (0.3 mcg/kg) or Midazolam (0.05 mg/kg), both with Fentanyl (1 mcg/kg). Sedation depth was assessed using the Ramsay Sedation Scale (RSS) and recovery by the Post-Anesthesia Recovery Score (PARS). All procedures were performed by the same endoscopist; sedation was administered by an independent anesthesiologist. Results Dexmedetomidine led to significantly higher patient and endoscopist satisfaction, shorter recovery time (9.5 ± 1.1 vs. 22.4 ± 7.7 min, p < 0.05), and reduced anxiety and discomfort. Adverse effects were fewer but not significantly different. Vital signs remained stable in both groups. Conclusion Dexmedetomidine and Fentanyl offers a more effective and better-tolerated sedation option than Midazolam and Fentanyl for upper endoscopy, with higher satisfaction and faster recovery.