Safety, satisfaction, and recovery: comparing Dexmedetomidine and Midazolam in sedation for upper endoscopy

Safety, satisfaction, and recovery: comparing Dexmedetomidine and Midazolam in sedation for upper endoscopy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Safety, satisfaction, and recovery: comparing Dexmedetomidine and Midazolam in sedation for upper endoscopy Ibrahim Ghoul, Aidah Alkaissi, Wael Sadaqa, Qusay Abdoh, Shadi Khilfeh, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6758872/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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. Methods A prospective observational 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 randomly 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. Dexmedetomidine Midazolam sedation endoscopy recovery time patient satisfaction Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Effective sedation is vital in upper GI endoscopy for patient comfort, reduced anxiety and pain, and procedural success ( 1 – 4 ). It enhances cooperation and completion rates ( 5 , 6 ). However, challenges include discomfort without sedation and risks like respiratory depression, especially in high-risk patients ( 7 , 8 ). Sedation must be tailored to individual needs ( 2 , 3 ). While benzodiazepines with opioids are standard, they carry respiratory risks ( 1 ); propofol offers faster recovery but requires close monitoring ( 4 , 7 ). Hypnosis is rarely used ( 9 ). Midazolam is widely favored due to its rapid onset, short duration, and good safety profile, with better pharmacokinetics than diazepam ( 10 , 11 ). It offers effective anxiolysis, amnesia, and flexible administration routes ( 10 , 12 ). Downsides include slower recovery than propofol, less satisfaction, and possible respiratory depression ( 10 , 12 ). Dexmedetomidine yields deeper sedation, greater satisfaction, and fewer respiratory issues than midazolam, with less pain and lower analgesic needs ( 13 – 17 ). Though it may cause bradycardia and hypotension, interventions are rarely needed ( 14 , 16 ). Recovery times are similar or slightly better, especially in elderly or high-risk patients ( 17 ). Although both Midazolam and Dexmedetomidine are commonly used, data comparing their safety and effectiveness in upper GI endoscopy especially in Middle Eastern settings like Palestine are limited. This study addresses that gap by comparing both drugs (with Fentanyl) in terms of sedation depth, recovery, adverse effects, and satisfaction, aiming to guide best practices in endoscopy sedation. Methods Study Design This prospective observational study compared the efficacy and safety of Dexmedetomidine vs. Midazolam in adult patients undergoing elective upper GI endoscopy. Patients were divided randomly into two groups using via computer-generated randomization sequence: one received Dexmedetomidine, the other Midazolam. Baseline data were collected pre-sedation; post-sedation outcomes (comfort, sedation depth, complications) were assessed afterward. One endoscopist performed all procedures; sedation was managed by an anesthesiologist uninvolved in data analysis. Study Setting and Site The study was conducted in the Endoscopic Department at An-Najah National University Hospital, Nablus, Palestine. This department provides diagnostic and therapeutic endoscopic services under standardized protocols established by the hospital’s endoscopy team. All procedures occurred in a clinical setting equipped with emergency resuscitation facilities, ensuring patient safety throughout the study period. Study Population and Sampling This Institutional Review Board -approved study included 68 outpatients (aged 18–60) undergoing elective upper endoscopy at An-Najah Hospital. Patients were ASA I–II; key exclusions included ASA ≥ III, drug allergies, pregnancy, and psychiatric issues. Data were collected from Oct 2021–Jan 2022. Sample size (34/group) was based on expected satisfaction differences. Consent and confidentiality were ensured. Data Collection Tools and Procedure Three tools were used: Sociodemographic Sheet – recorded patient ID, age, gender, BMI, education, and indication for endoscopy. Sedation/Recovery Record – tracked time to sedation (RSS ≥ 4), recovery (RSS = 2), and procedure duration. Follow-up Sheet – documented vitals and sedation depth at baseline, pre-endoscopy, 5 minutes into the procedure or at change points, and 1 hour post-procedure. Adverse events (e.g., bradycardia, hypotension, hypoxia, discomfort) were noted. Tools were validated by a panel (2 anesthesiologists, 1 anesthesia academic, 1 anesthesia nurse, 1 statistician). Data Collection Process Pre-procedure Consent obtained; ASA class and baseline vitals recorded; patients advised to have post-procedure supervision. During procedure Patients were laterally positioned; vitals monitored. Dexmedetomidine group : 0.3 mcg/kg Dexmedetomidine + 1 mcg/kg Fentanyl IV 10 mins before, then continuous infusion. Midazolam group : 0.05 mg/kg Midazolam + 1 mcg/kg Fentanyl IV, with repeated doses every 2–5 mins as needed. Sedation depth assessed using RSS, targeting ≥ 4. Post-procedure Monitored until RSS = 2. Discharge readiness evaluated using PARS. Patients received post-endoscopy care instructions. Satisfaction of patients and endoscopists was assessed (1–10 scale) covering anxiety, discomfort, gagging, technical difficulty, and sedation adequacy. Ethical Considerations Approved by An-Najah IRB, in line with the Declaration of Helsinki. Written consent obtained. Participants could withdraw anytime. Data were anonymized and securely stored. All procedures were supervised by experienced medical staff. Data Analysis Data were analyzed using SPSS v20. Means ± SD were used for continuous variables (e.g., recovery time, satisfaction), compared with independent t-tests. Categorical data (e.g., adverse effects, vitals) were analyzed via chi-square tests. Significance was set at p < 0.05. Result This study compared Midazolam and Dexmedetomidine during sedated upper endoscopy by evaluating vital signs, Ramsay Sedation Scale scores, time to full sedation and recovery, use of additional sedatives or side-effect treatments, as well as patient anxiety, discomfort, gagging, and satisfaction, and endoscopist-rated technical difficulty, sedation adequacy, and patient tolerance. Demographic Data and indications for endoscopy The study included 68 patients randomized equally to Midazolam or Dexmedetomidine groups (n = 34 each). No significant differences were found in sex, age, BMI, smoking, or education. Endoscopy duration was longer with Dexmedetomidine (11.0 ± 1.9 min) than Midazolam (9.9 ± 1.5 min), p = 0.008. Significant group differences were found in indications: dysphagia (50% vs. 35.3%, p = 0.032), reflux (20.5% vs. 50%, p = 0.035), and dyspepsia (29.4% vs. 14.7%, p = 0.031). Table 1 Demographic Data of patients in Midazolam group and Dexmedetomidine group. Data is reported as Mean Standard deviation (SD) unless otherwise stated. Variable Midazolam group (n = 34) Dexmedetomidine group (n = 34) p Age, year* 39.8 ± 13.0 40.8 ± 11.4 0.744 Sex, Male%/Female% 47.05%/52.95% 52.95% /47.05%/ 0.809 Body mass index, kg/m2* 28.1 ± 6.0 28.4 ± 4.8 0.429 Duration of endoscopy, min* 9.9 ± 1.5 11.0 ± 1.9 0.008 Smoking% 35.29% 20.58% 0.280 Education level, n grammar school% 2.94% 0% 0.543 high school% 29.4% 20.59% 0.475 College% 38.23% 35.29% 0.841 graduate school% 29.4% 41.17% 0.542 Indications for endoscopy Dysphagia% 35.29% 50% 0.032 Esophageal reflux symptoms% 50% 20.59% 0.035 Dyspepsia% 14.70% 29.41% 0.031 Pre and post procedural patient satisfaction Before sedation, groups showed similar expected satisfaction and discomfort (p > 0.05); Midazolam had less gagging (p = 0.020), Dexmedetomidine less anxiety (p = 0.018). After sedation, Dexmedetomidine had higher satisfaction (9.1 vs. 8.06), and lower discomfort (0.7 vs. 1.7) and anxiety (0.5 vs. 1.8), all p = 0.001; gagging was similar (Table 2 ; Fig. 2 ). Table 2 Pre and post procedural patient satisfaction. Data presents as mean (± SD) Variable Midazolam group (n = 34) Dexmedetomidine group (n = 34) p Pre procedure Expected Satisfaction 7.7 ± 1.2 7.1 ± 1.9 0.228 Expected Discomfort 1.7 ± 1.6 2.1 ± 1.8 0.515 Expected gagging 1.0 ± 1.1 1.6 ± 1.1 0.020 Anxiety Score 2.6 ± 0.9 2.1 ± 1.4 0.018 Post procedure Satisfaction 8.06 ± 0.9 9.1 ± 1.0 0.001 Discomfort 1.7 ± 1.1 0.7 ± 0.9 0.001 Gagging 0.7 ± 0.9 0.6 ± 1.5 0.077 Anxiety 1.8 ± 1.4 0.5 ± 0.8 0.001 Post-procedural patient satisfaction Endoscopy specialist satisfaction Dexmedetomidine patients had higher endoscopist satisfaction (8.7 vs. 8.2, p = 0.001) and less discomfort, gagging, retching, and technical difficulty (all p < 0.05) than Midazolam, outperforming it in all endoscopist-assessed measures (Fig. 3 ). Recovery data in Midazolam and Dexmedetomidine groups Dexmedetomidine patients were recovered faster than Midazolam patients (Fig. 4), Midazolam patients need 48.8 ± 6.0 min to recover while the Dexmedetomidine patients need 18.0 ± 5.2 min and this difference significant since the p < .05, Midazolam need 2.4 ± 7.7 min to sedate while the Dexmedetomidine need 9.5 ± 1.1 min and this difference significant since the p < .05 (Fig. 5 ). Vital signs and Adverse effect of the patients in both Midazolam and Dexmedetomidine groups There were no major differences in vital signs between the two groups, except for breathing rate. The Dexmedetomidine group had a lower respiratory rate (16.7 ± 1.9) compared to the Midazolam group (18.6 ± 4.7), p = 0.028. Blood pressure, heart rate, and oxygen levels were generally the same in both groups. However, heart rate was lower in the Dexmedetomidine group at one time point (p = 0.049), and respiratory rate was also lower at two time points (p = 0.004 and p = 0.001) (Table 3 ). Hypertension was the most common side effect in both groups. Although side effects were less frequent with Dexmedetomidine than Midazolam, the difference was not statistically significant. Table 3 Vital signs of the patients in both Midazolam and Dexmedetomidine groups Variable Midazolam group (n = 34) Dexmedetomidine group (n = 34) p Mean Arterial Pressure 90.7 ± 6.3 91.4 ± 8.5 0.713 Heart Rate 80.7 ± 11.5 77.4 ± 11.6 0.238 oxygen saturation 97.7 ± 1.3 97.8 ± 2.5 0.861 Respiratory Rate 18.6 ± 4.7 16.7 ± 1.9 0.028 Data displayed as Mean (± SD) Discussion This study found Dexmedetomidine to be safer and more effective than Midazolam for upper GI endoscopy, with higher patient and endoscopist satisfaction, fewer side effects, more stable vital signs, and faster recovery. These benefits support its use over Midazolam, which is linked to more adverse effects and slower recovery ( 18 – 20 ). Both drugs were combined with Fentanyl, aligning with prior studies ( 21 , 22 ). Dexmedetomidine patients had less discomfort, anxiety, and retching, consistent with findings from Barends et al. (2017), Zhang et al. (2016), and Kilic et al. (2011) ( 13 , 23 , 24 ). Recovery was significantly faster with Dexmedetomidine (18.0 vs. 48.8 minutes), though onset was slower. Vital signs were largely similar, but Dexmedetomidine showed fewer respiratory issues ( 16 , 19 ). Fewer adverse events occurred with Dexmedetomidine (5 vs. 18), supporting its better safety profile ( 23 , 24 ). Limitations include the single-center design, small sample size, lack of long-term follow-up, and no Propofol comparison. Conclusion Dexmedetomidine provided better patient and provider satisfaction, faster recovery, and fewer side effects than Midazolam. These results support its use as a safer and more effective option for sedation in upper endoscopy and suggest it could improve clinical outcomes and workflow. Abbreviations ASA American Society of Anesthesiologists RSS Ramsay Sedation Scale Declarations Ethics approval and consent to participate The study received ethical approval from the IRB at An-Najah National University and the Ethics Committee of An-Najah National University Hospital. All patients received a clear explanation of the study objectives, protocol, and potential risks and benefits. Availability of Data and Materials The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Acknowledgements The authors would like to thank An-Najah National University (www.najah.edu) for the technical support provided to publish the present manuscript. Consent for publication Consent for Publication is Not Applicable. Competing interests The authors declare no competing interests Clinical trial registration This research did not involve a clinical trial; no clinical trial registration is applicable. Author contributions I.G. and A.A. conceptualized the study and prepared the main manuscript text. W.S. developed the anesthesia protocol. Data collection was conducted by Q.A., S.K., R.N., M.A., M.F.H and A.A. All authors reviewed and approved the final manuscript References Moon S-H. Sedation regimens for gastrointestinal endoscopy. Clin endoscopy. 2014;47(2):135. Triantafillidis JK, Merikas E, Nikolakis D, Papalois AE. Sedation in gastrointestinal endoscopy: current issues. World J gastroenterology: WJG. 2013;19(4):463. 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The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: a prospective, randomized study. Can J Gastroenterol Hepatol. 2007;21(1):25–9. Zhang F, Sun HR, Zheng ZB, Liao R, Liu J. Dexmedetomidine versus midazolam for sedation during endoscopy: a meta-analysis. Experimental Therapeutic Med. 2016;11(6):2519–24. Kilic N, Sahin S, Aksu H, Yavascaoglu B, Gurbet A, Turker G, et al. Conscious sedation for endoscopic retrograde cholangiopancreatography: dexmedetomidine versus midazolam. Eurasian J Med. 2011;43(1):13. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6758872","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":476981479,"identity":"48115064-c0c7-424d-9827-b64f99061b99","order_by":0,"name":"Ibrahim Ghoul","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYBACNjBisJADEgnMQIKxgUgtEsbEa2GAakkEqSROCx8D+7UHH9sk0rezH3j4uYDBRnbDAYJW8JQbzmyTyN3Zk5AsPYMhzZgYLWnSvEAtGw4kJEjzMBxOJFpLusH5B8m/eRj+E6OF/RhIS4LBjYQ0oC0HiNDCzMMmOeOchOGGGw/SrHkMko1nEtIi397+TOJDmY28wfmc5Ns8FXayfYS0MDDzGEBZPAkMDAb4lMIB+wMYg6Dxo2AUjIJRMEIBAHH+O6jzJ9NsAAAAAElFTkSuQmCC","orcid":"","institution":"An-Najah National University Hospital, An-Najah National University","correspondingAuthor":true,"prefix":"","firstName":"Ibrahim","middleName":"","lastName":"Ghoul","suffix":""},{"id":476981480,"identity":"0d193ffd-bf2b-46e4-9ad6-2a82f858c166","order_by":1,"name":"Aidah Alkaissi","email":"","orcid":"","institution":"An-Najah National University","correspondingAuthor":false,"prefix":"","firstName":"Aidah","middleName":"","lastName":"Alkaissi","suffix":""},{"id":476981481,"identity":"3003a3f2-1ea8-434a-abf6-6c6957faadc6","order_by":2,"name":"Wael Sadaqa","email":"","orcid":"","institution":"An-Najah National University","correspondingAuthor":false,"prefix":"","firstName":"Wael","middleName":"","lastName":"Sadaqa","suffix":""},{"id":476981482,"identity":"fa78771a-6017-4eee-b16d-1669a5bf2111","order_by":3,"name":"Qusay Abdoh","email":"","orcid":"","institution":"An-Najah National University Hospital, An-Najah National University","correspondingAuthor":false,"prefix":"","firstName":"Qusay","middleName":"","lastName":"Abdoh","suffix":""},{"id":476981483,"identity":"5e4f8dfc-48e4-406d-9322-94ee02c43f67","order_by":4,"name":"Shadi Khilfeh","email":"","orcid":"","institution":"An-Najah National University","correspondingAuthor":false,"prefix":"","firstName":"Shadi","middleName":"","lastName":"Khilfeh","suffix":""},{"id":476981484,"identity":"b73f7823-b8de-49db-88f7-7a5cf372d95a","order_by":5,"name":"Raneen Nazzal","email":"","orcid":"","institution":"An-Najah National University Hospital, An-Najah National University","correspondingAuthor":false,"prefix":"","firstName":"Raneen","middleName":"","lastName":"Nazzal","suffix":""},{"id":476981487,"identity":"721bceeb-30d7-4c2f-8b91-0e0a84d6d205","order_by":6,"name":"Muath Almasri","email":"","orcid":"","institution":"An-Najah National University Hospital, An-Najah National University","correspondingAuthor":false,"prefix":"","firstName":"Muath","middleName":"","lastName":"Almasri","suffix":""},{"id":476981490,"identity":"045350a9-ffc7-4364-b403-3baacb7f30e3","order_by":7,"name":"Mohammed F. Hayek","email":"","orcid":"","institution":"An-Najah National University","correspondingAuthor":false,"prefix":"","firstName":"Mohammed","middleName":"F.","lastName":"Hayek","suffix":""},{"id":476981491,"identity":"ed1f7536-9cf9-405c-9f62-c3f98a78c907","order_by":8,"name":"Amro Adas","email":"","orcid":"","institution":"An-Najah National University Hospital, An-Najah National University","correspondingAuthor":false,"prefix":"","firstName":"Amro","middleName":"","lastName":"Adas","suffix":""}],"badges":[],"createdAt":"2025-05-27 11:23:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6758872/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6758872/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85647851,"identity":"1e49cbd1-f21c-4136-bde7-e73d2edef752","added_by":"auto","created_at":"2025-06-30 08:51:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":452689,"visible":true,"origin":"","legend":"\u003cp\u003eData collection Flow Diagram\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6758872/v1/fc9f369c44a487006b441c38.png"},{"id":85647842,"identity":"2cf002bf-a95b-4cae-8358-8f8aa1833dbc","added_by":"auto","created_at":"2025-06-30 08:51:05","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":8539,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003epatients perceptions\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6758872/v1/51d25be4779b1c4207a9407e.png"},{"id":85647833,"identity":"6061377c-e050-4d90-b8b7-9502dd306f24","added_by":"auto","created_at":"2025-06-30 08:51:04","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":9046,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eEndoscopy specialist perception\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-6758872/v1/d91d276e8ec3fb8e82c5f184.png"},{"id":85647836,"identity":"a37612f0-999d-4433-ac9e-e1f1dd54bebf","added_by":"auto","created_at":"2025-06-30 08:51:04","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":7560,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003epatients fully recovered time per min\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-6758872/v1/b1534c3abe7c274c2940a04b.png"},{"id":90661940,"identity":"81d06987-bbb8-4155-bdcf-fbff5cb3f195","added_by":"auto","created_at":"2025-09-05 11:39:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1351057,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6758872/v1/2e2a9e36-f031-4cff-a031-17c090060cee.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Safety, satisfaction, and recovery: comparing Dexmedetomidine and Midazolam in sedation for upper endoscopy","fulltext":[{"header":"Background","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eEffective sedation is vital in upper GI endoscopy for patient comfort, reduced anxiety and pain, and procedural success (\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). It enhances cooperation and completion rates (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). However, challenges include discomfort without sedation and risks like respiratory depression, especially in high-risk patients (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Sedation must be tailored to individual needs (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). While benzodiazepines with opioids are standard, they carry respiratory risks (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e); propofol offers faster recovery but requires close monitoring (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Hypnosis is rarely used (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Midazolam is widely favored due to its rapid onset, short duration, and good safety profile, with better pharmacokinetics than diazepam (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). It offers effective anxiolysis, amnesia, and flexible administration routes (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Downsides include slower recovery than propofol, less satisfaction, and possible respiratory depression (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Dexmedetomidine yields deeper sedation, greater satisfaction, and fewer respiratory issues than midazolam, with less pain and lower analgesic needs (\u003cspan additionalcitationids=\"CR14 CR15 CR16\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Though it may cause bradycardia and hypotension, interventions are rarely needed (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Recovery times are similar or slightly better, especially in elderly or high-risk patients (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough both Midazolam and Dexmedetomidine are commonly used, data comparing their safety and effectiveness in upper GI endoscopy especially in Middle Eastern settings like Palestine are limited. This study addresses that gap by comparing both drugs (with Fentanyl) in terms of sedation depth, recovery, adverse effects, and satisfaction, aiming to guide best practices in endoscopy sedation.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThis prospective observational study compared the efficacy and safety of Dexmedetomidine vs. Midazolam in adult patients undergoing elective upper GI endoscopy. Patients were divided randomly into two groups using via computer-generated randomization sequence: one received Dexmedetomidine, the other Midazolam. Baseline data were collected pre-sedation; post-sedation outcomes (comfort, sedation depth, complications) were assessed afterward. One endoscopist performed all procedures; sedation was managed by an anesthesiologist uninvolved in data analysis.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Setting and Site\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe study was conducted in the Endoscopic Department at An-Najah National University Hospital, Nablus, Palestine. This department provides diagnostic and therapeutic endoscopic services under standardized protocols established by the hospital\u0026rsquo;s endoscopy team. All procedures occurred in a clinical setting equipped with emergency resuscitation facilities, ensuring patient safety throughout the study period.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eStudy Population and Sampling\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThis Institutional Review Board -approved study included 68 outpatients (aged 18\u0026ndash;60) undergoing elective upper endoscopy at An-Najah Hospital. Patients were ASA I\u0026ndash;II; key exclusions included ASA\u0026thinsp;\u0026ge;\u0026thinsp;III, drug allergies, pregnancy, and psychiatric issues. Data were collected from Oct 2021\u0026ndash;Jan 2022. Sample size (34/group) was based on expected satisfaction differences. Consent and confidentiality were ensured.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eData Collection Tools and Procedure\u003c/h3\u003e\n\u003cp\u003eThree tools were used:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSociodemographic Sheet \u0026ndash; recorded patient ID, age, gender, BMI, education, and indication for endoscopy.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSedation/Recovery Record \u0026ndash; tracked time to sedation (RSS\u0026thinsp;\u0026ge;\u0026thinsp;4), recovery (RSS\u0026thinsp;=\u0026thinsp;2), and procedure duration.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eFollow-up Sheet \u0026ndash; documented vitals and sedation depth at baseline, pre-endoscopy, 5 minutes into the procedure or at change points, and 1 hour post-procedure. Adverse events (e.g., bradycardia, hypotension, hypoxia, discomfort) were noted.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eTools were validated by a panel (2 anesthesiologists, 1 anesthesia academic, 1 anesthesia nurse, 1 statistician).\u003c/p\u003e\n\u003ch3\u003eData Collection Process\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003ePre-procedure\u003c/strong\u003e \u003cp\u003eConsent obtained; ASA class and baseline vitals recorded; patients advised to have post-procedure supervision.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDuring procedure\u003c/strong\u003e \u003cp\u003ePatients were laterally positioned; vitals monitored.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eDexmedetomidine group\u003c/em\u003e: 0.3 mcg/kg Dexmedetomidine\u0026thinsp;+\u0026thinsp;1 mcg/kg Fentanyl IV 10 mins before, then continuous infusion.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eMidazolam group\u003c/em\u003e: 0.05 mg/kg Midazolam\u0026thinsp;+\u0026thinsp;1 mcg/kg Fentanyl IV, with repeated doses every 2\u0026ndash;5 mins as needed.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSedation depth assessed using RSS, targeting\u0026thinsp;\u0026ge;\u0026thinsp;4.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePost-procedure\u003c/strong\u003e \u003cp\u003eMonitored until RSS\u0026thinsp;=\u0026thinsp;2. Discharge readiness evaluated using PARS. Patients received post-endoscopy care instructions.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eSatisfaction of patients and endoscopists was assessed (1\u0026ndash;10 scale) covering anxiety, discomfort, gagging, technical difficulty, and sedation adequacy.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003eApproved by An-Najah IRB, in line with the Declaration of Helsinki. Written consent obtained. Participants could withdraw anytime. Data were anonymized and securely stored. All procedures were supervised by experienced medical staff.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS v20. Means\u0026thinsp;\u0026plusmn;\u0026thinsp;SD were used for continuous variables (e.g., recovery time, satisfaction), compared with independent t-tests. Categorical data (e.g., adverse effects, vitals) were analyzed via chi-square tests. Significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cp\u003eThis study compared Midazolam and Dexmedetomidine during sedated upper endoscopy by evaluating vital signs, Ramsay Sedation Scale scores, time to full sedation and recovery, use of additional sedatives or side-effect treatments, as well as patient anxiety, discomfort, gagging, and satisfaction, and endoscopist-rated technical difficulty, sedation adequacy, and patient tolerance.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDemographic Data and indications for endoscopy\u003c/h2\u003e \u003cp\u003eThe study included 68 patients randomized equally to Midazolam or Dexmedetomidine groups (n\u0026thinsp;=\u0026thinsp;34 each). No significant differences were found in sex, age, BMI, smoking, or education. Endoscopy duration was longer with Dexmedetomidine (11.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9 min) than Midazolam (9.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 min), p\u0026thinsp;=\u0026thinsp;0.008. Significant group differences were found in indications: dysphagia (50% vs. 35.3%, p\u0026thinsp;=\u0026thinsp;0.032), reflux (20.5% vs. 50%, p\u0026thinsp;=\u0026thinsp;0.035), and dyspepsia (29.4% vs. 14.7%, p\u0026thinsp;=\u0026thinsp;0.031).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Data of patients in Midazolam group and Dexmedetomidine group. Data is reported as Mean Standard deviation (SD) unless otherwise stated.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMidazolam group (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDexmedetomidine group (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, year*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39.8\u0026thinsp;\u0026plusmn;\u0026thinsp;13.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.744\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, Male%/Female%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.05%/52.95%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.95%\u0026nbsp;/47.05%/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.809\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass index, kg/m2*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.429\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of endoscopy, min*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.29%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.58%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.280\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level, n\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003egrammar school%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.94%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.543\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehigh school%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.59%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.475\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollege%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.23%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.29%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.841\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003egraduate school%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.17%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.542\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndications for endoscopy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDysphagia%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.29%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEsophageal reflux symptoms%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.59%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyspepsia%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.70%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.41%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePre and post procedural patient satisfaction\u003c/h2\u003e \u003cp\u003eBefore sedation, groups showed similar expected satisfaction and discomfort (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05); Midazolam had less gagging (p\u0026thinsp;=\u0026thinsp;0.020), Dexmedetomidine less anxiety (p\u0026thinsp;=\u0026thinsp;0.018). After sedation, Dexmedetomidine had higher satisfaction (9.1 vs. 8.06), and lower discomfort (0.7 vs. 1.7) and anxiety (0.5 vs. 1.8), all p\u0026thinsp;=\u0026thinsp;0.001; gagging was similar (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e; Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePre and post procedural patient satisfaction. Data presents as mean (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMidazolam group (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDexmedetomidine group (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre procedure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExpected Satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.228\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExpected Discomfort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.515\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExpected gagging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePost procedure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSatisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e8.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiscomfort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGagging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePost-procedural patient satisfaction\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eEndoscopy specialist satisfaction\u003c/h2\u003e \u003cp\u003eDexmedetomidine patients had higher endoscopist satisfaction (8.7 vs. 8.2, p\u0026thinsp;=\u0026thinsp;0.001) and less discomfort, gagging, retching, and technical difficulty (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) than Midazolam, outperforming it in all endoscopist-assessed measures (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eRecovery data in Midazolam and Dexmedetomidine groups\u003c/h2\u003e \u003cp\u003eDexmedetomidine patients were recovered faster than Midazolam patients (Fig.\u0026nbsp;4), Midazolam patients need 48.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.0 min to recover while the Dexmedetomidine patients need 18.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2 min and this difference significant since the p\u0026thinsp;\u0026lt;\u0026thinsp;.05, Midazolam need 2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.7 min to sedate while the Dexmedetomidine need 9.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 min and this difference significant since the p\u0026thinsp;\u0026lt;\u0026thinsp;.05 (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eVital signs and Adverse effect of the patients in both Midazolam and Dexmedetomidine groups\u003c/h2\u003e \u003cp\u003eThere were no major differences in vital signs between the two groups, except for breathing rate. The Dexmedetomidine group had a lower respiratory rate (16.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9) compared to the Midazolam group (18.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7), p\u0026thinsp;=\u0026thinsp;0.028. Blood pressure, heart rate, and oxygen levels were generally the same in both groups. However, heart rate was lower in the Dexmedetomidine group at one time point (p\u0026thinsp;=\u0026thinsp;0.049), and respiratory rate was also lower at two time points (p\u0026thinsp;=\u0026thinsp;0.004 and p\u0026thinsp;=\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Hypertension was the most common side effect in both groups. Although side effects were less frequent with Dexmedetomidine than Midazolam, the difference was not statistically significant.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVital signs of the patients in both Midazolam and Dexmedetomidine groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMidazolam group (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDexmedetomidine group (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean Arterial Pressure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.713\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHeart Rate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80.7\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.4\u0026thinsp;\u0026plusmn;\u0026thinsp;11.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.238\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eoxygen saturation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.861\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRespiratory Rate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eData displayed as Mean (\u0026plusmn;\u0026thinsp;SD)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study found Dexmedetomidine to be safer and more effective than Midazolam for upper GI endoscopy, with higher patient and endoscopist satisfaction, fewer side effects, more stable vital signs, and faster recovery. These benefits support its use over Midazolam, which is linked to more adverse effects and slower recovery (\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Both drugs were combined with Fentanyl, aligning with prior studies (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Dexmedetomidine patients had less discomfort, anxiety, and retching, consistent with findings from Barends et al. (2017), Zhang et al. (2016), and Kilic et al. (2011) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Recovery was significantly faster with Dexmedetomidine (18.0 vs. 48.8 minutes), though onset was slower. Vital signs were largely similar, but Dexmedetomidine showed fewer respiratory issues (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Fewer adverse events occurred with Dexmedetomidine (5 vs. 18), supporting its better safety profile (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Limitations include the single-center design, small sample size, lack of long-term follow-up, and no Propofol comparison.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDexmedetomidine provided better patient and provider satisfaction, faster recovery, and fewer side effects than Midazolam. These results support its use as a safer and more effective option for sedation in upper endoscopy and suggest it could improve clinical outcomes and workflow.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eAmerican Society of Anesthesiologists\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eRSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eRamsay Sedation Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received ethical approval from the IRB at An-Najah National University and the Ethics Committee of An-Najah National University Hospital. All patients received a clear explanation of the study objectives, protocol, and potential risks and benefits.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank An-Najah National University (www.najah.edu) for the technical support provided to publish the present manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent for Publication is Not Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not involve a clinical trial; no clinical trial registration is applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI.G. and A.A. conceptualized the study and prepared the main manuscript text. W.S. developed the anesthesia protocol. Data collection was conducted by Q.A., S.K., R.N., M.A., M.F.H and A.A. All authors reviewed and approved the final manuscript\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMoon S-H. Sedation regimens for gastrointestinal endoscopy. Clin endoscopy. 2014;47(2):135.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTriantafillidis JK, Merikas E, Nikolakis D, Papalois AE. Sedation in gastrointestinal endoscopy: current issues. World J gastroenterology: WJG. 2013;19(4):463.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSidhu R, Turnbull D, Haboubi H, Leeds JS, Healey C, Hebbar S, et al. British Society of Gastroenterology guidelines on sedation in gastrointestinal endoscopy. Gut. 2024;73(2):1\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTarway NK, Jain M, Rajavel V, Melpakkam S, Srinivasan V, Ravi R, et al. Patient satisfaction and safety profile with sedation during gastrointestinal endoscopy. Indian J Gastroenterol. 2017;36:330\u0026ndash;1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDaneshmend T, Bell G, Logan R. Sedation for upper gastrointestinal endoscopy: results of a nationwide survey. Gut. 1991;32(1):12\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBalsells F, Wyllie R, Kay M, Steffen R. Use of conscious sedation for lower and upper gastrointestinal endoscopic examinations in children, adolescents, and young adults: a twelve-year review. Gastrointest Endosc. 1997;45(5):375\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZaher ONH, El Kabarity RH, Ali RMM, Mohamed MM. Dexmedetomidine versus ketamine-propofol for sedation of obese patients undergoing upper gastrointestinal endoscopy. QJM Int J Med. 2021;114.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSundararaman L, Goudra B. Sedation for GI Endoscopy in the Morbidly Obese: Challenges and Possible Solutions. J Clin Med. 2024;13(16):4635.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZimmerman J. Hypnotic technique for sedation of patients during upper gastrointestinal endoscopy. Am J Clin Hypn. 1998;40(4):284\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eConway A, Rolley J, Sutherland JR. Midazolam for sedation before procedures. Cochrane Database Syst Reviews. 2016(5).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFassoulaki A, Theodoraki K, Melemeni A. Pharmacology of sedation agents and reversal agents. Digestion. 2010;82(2):80\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcQuaid KR, Laine L. A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures. Gastrointest Endosc. 2008;67(6):910\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarends CR, Absalom A, van Minnen B, Vissink A, Visser A. Dexmedetomidine versus midazolam in procedural sedation. A systematic review of efficacy and safety. PLoS ONE. 2017;12(1):e0169525.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKumari R, Jain K, Agarwal R, Dhooria S, Sehgal IS, Aggarwal AN. Fixed dexmedetomidine infusion versus fixed-dose midazolam bolus as primary sedative for maintaining intra-procedural sedation during endobronchial ultrasound-guided transbronchial needle aspiration: a double blind randomized controlled trial. Expert Rev Respir Med. 2021;15(12):1597\u0026ndash;604.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuldiken IN, Gurler G, Delilbasi C. Comparison of Dexmedetomidine and Midazolam in Conscious Sedation During Dental Implant Surgery: A Randomized Clinical Trial. Int J Oral Maxillofacial Implants. 2021;36(6).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInatomi O, Imai T, Fujimoto T, Takahashi K, Yokota Y, Yamashita N, et al. Dexmedetomidine is safe and reduces the additional dose of midazolam for sedation during endoscopic retrograde cholangiopancreatography in very elderly patients. BMC Gastroenterol. 2018;18:1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu W, Ge X, Gao F, Kan Q, Wang S, Wang Y et al. Safety and efficacy of dexmedetomidine vs. midazolam in complex gastrointestinal endoscopy: a systematic review and meta-analysis. Clin Res Hepatol Gastroenterol. 2024:102315.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVermeeren A. Residual effects of hypnotics: epidemiology and clinical implications. CNS Drugs. 2004;18(5):297\u0026ndash;328.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSethi P, Mohammed S, Bhatia PK, Gupta N. Dexmedetomidine versus midazolam for conscious sedation in endoscopic retrograde cholangiopancreatography: An open-label randomised controlled trial. Indian J Anaesth. 2014;58(1):18\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLu Z, Li W, Chen H, Qian Y. Efficacy of a dexmedetomidine\u0026ndash;remifentanil combination compared with a midazolam\u0026ndash;remifentanil combination for conscious sedation during therapeutic endoscopic retrograde cholangio-pancreatography: a prospective, randomized, single-blinded preliminary trial. Dig Dis Sci. 2018;63:1633\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu W, Chen Q, Zhang L-c. Chen W-h. Dexmedetomidine versus midazolam for sedation in upper gastrointestinal endoscopy. J Int Med Res. 2014;42(2):516\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDemiraran Y, Korkut E, Tamer A, Yorulmaz I, Kocaman B, Sezen G, et al. The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: a prospective, randomized study. Can J Gastroenterol Hepatol. 2007;21(1):25\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang F, Sun HR, Zheng ZB, Liao R, Liu J. Dexmedetomidine versus midazolam for sedation during endoscopy: a meta-analysis. Experimental Therapeutic Med. 2016;11(6):2519\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKilic N, Sahin S, Aksu H, Yavascaoglu B, Gurbet A, Turker G, et al. Conscious sedation for endoscopic retrograde cholangiopancreatography: dexmedetomidine versus midazolam. Eurasian J Med. 2011;43(1):13.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Dexmedetomidine, Midazolam, sedation, endoscopy, recovery time, patient satisfaction","lastPublishedDoi":"10.21203/rs.3.rs-6758872/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6758872/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eUpper 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA prospective observational 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\u0026ndash;60 years were randomly 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eDexmedetomidine led to significantly higher patient and endoscopist satisfaction, shorter recovery time (9.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 vs. 22.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.7 min, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and reduced anxiety and discomfort. Adverse effects were fewer but not significantly different. Vital signs remained stable in both groups.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eDexmedetomidine and Fentanyl offers a more effective and better-tolerated sedation option than Midazolam and Fentanyl for upper endoscopy, with higher satisfaction and faster recovery.\u003c/p\u003e","manuscriptTitle":"Safety, satisfaction, and recovery: comparing Dexmedetomidine and Midazolam in sedation for upper endoscopy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-30 08:50:18","doi":"10.21203/rs.3.rs-6758872/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d9602da9-9b57-4cd5-9aa2-e9fac9dc54af","owner":[],"postedDate":"June 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-05T11:38:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-30 08:50:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6758872","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6758872","identity":"rs-6758872","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}