The comparison of dexmedetomidine and midazolam used for sedation of patients undergoing upper gastrointestinal endoscopy

The comparison of dexmedetomidine and midazolam used for sedation of patients undergoing upper gastrointestinal 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 Article The comparison of dexmedetomidine and midazolam used for sedation of patients undergoing upper gastrointestinal endoscopy Ibrahim Ghoul, Aidah Alkaissi, Wael Sadaqa, Qusay Abdoh, Shadi Khilfeh, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6261635/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: Endoscopic procedures are vital for diagnosing and treating various conditions but can cause significant discomfort and pain. Sedation is essential to minimize pain, mobility, gagging, and nausea while maintaining respiratory and cardiovascular stability. This study compares the efficacy and safety of Midazolam and Dexmedetomidine in sedation, focusing on patient and endoscopist satisfaction, recovery time, and adverse effects during upper endoscopy. Methodology: A prospective observational study was conducted on 68 patients (ages 18–60) classified as ASA grades I or II. The study took place at An-Najah National University Hospital, Nablus, Palestine, from October 2021 to January 2022. Participants were informed about the study's purpose, protocol, and consent process, and written consent was obtained. Results: Dexmedetomidine showed significantly higher patient and endoscopist satisfaction, faster recovery times, and less discomfort and anxiety compared to Midazolam (p<0.05). Patients sedated with Dexmedetomidine recovered more quickly, with a mean recovery time of 9.5 ± 1.1 minutes compared to 22.4 ± 7.7 minutes for Midazolam, demonstrating a statistically significant advantage (p<0.05). While Dexmedetomidine had fewer side effects, the difference was not statistically significant. No significant differences in vital signs were observed between the two groups. Conclusions: Dexmedetomidine outperformed Midazolam in recovery time, patient satisfaction, endoscopist satisfaction, and minimizing discomfort, anxiety, and retching. It presents a safe and effective alternative to Midazolam for sedation during upper endoscopy. Health sciences/Gastroenterology Health sciences/Health care Dexmedetomidine Midazolam sedation endoscopy recovery time gastrointestinal and patient satisfaction Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background In conscious sedation, patients can keep their response to pain and verbal stimuli without failing respiratory or cardiovascular function [ 1 ]. This type of sedation merges a benzodiazepine, and opioid and is commonly used in minor surgeries and endoscopy [ 2 ] [ 3 ]. Endoscopic procedures are essential for the treatment, diagnosis, and evaluation of many disorders like gastrointestinal tract bleeding, foreign body removal or in some complicated procedures like endoscopic retrograde cholangiopancreatography (ERCP), which uses x-ray guidance to accurately treat and diagnose diseases inside the pancreas, bile ducts, liver, and gallbladder [ 4 ]. During the procedure, pain, anxiety, fear, and retching may let patients to be uncooperative, and it can induce harmful respiratory and cardiovascular effects [ 5 ]. The endoscope is an irritating and painful procedure performed without analgesia and sedation [ 6 ]. During endoscopy, patients should be anesthetized to avoid mobility, pain, coughing, gagging, and nausea. So, sufficient analgesia and sedation agents should be given and monitored [ 7 ]. It is necessary to guarantee that the client's protective reflexes are intact but immobile [ 8 ]. After this type of anesthesia, the patient can recover his reactions and return home on the same day, this benefits both the patient and the hospital so that the occupancy rate in hospitals is reduced and the hospital can receive more cases per day. Other advantages of this type of sedation over general anesthesia are the speed of recovery, ease of response of the patient to the nurse when he awakens and the increase in his level of satisfaction and comfort [ 9 – 11 ]. While using sedative drugs, the aim is to do analgesia, amnesia, and quick patient recovery to the same level of consciousness before the procedure [ 12 ]. Midazolam is one of the benzodiazepines family with a short duration and rapid onset of action [ 13 ]. It triggers γ-aminobutyric acid receptors and causes central nervous system depression [ 14 ]. Midazolam was the most common sedative agent used in critical care units [ 15 ]. Dexmedetomidine is an antagonist and highly selective drug that works on alpha 2-adrenoceptor and has sedative, amnestic, sympatholytic, and analgesic properties [ 16 ]. Dexmedetomidine started to be used in the critical care unit in 1998, then in other medical applications [ 17 ]. Dexmedetomidine is a good surrogate to Midazolam in sedation [ 18 ]. With the increase in the use of Dexmedetomidine, many side effects appeared, such as bradycardia and hypotension [ 19 ]. Beneficent clinical applications of Dexmedetomidine sedation are found in endoscopic procedures and retrograde cholangiopancreatography [ 20 ]. In terms of the respiratory system, compared to Midazolam, Dexmedetomidine has been statistically shown to be more effective, it has a lower effect on oxygen saturation in the blood and more respiratory stability, as it leads to faster recovery, it is recommended to be used as an alternative, especially for people who suffer from respiratory problems [ 21 ] [ 22 ] [ 2 ]. Regarding the cardiovascular system, the most critical complication of Dexmedetomidine is bradycardia and hypotension [ 23 ]. However, other studies found no effect of hypotension or bradycardia. [ 21 ] [ 24 ]. The slow flow of the drug for ten minutes showed that the drug does not lead to a decrease in blood pressure, the correct preparation and administration of the drug give positive results regarding the safety of the circulatory system [ 25 ]. However, caution should be exercised while administering this drug to people with slow heartbeat problems or heart block [ 26 ]. And if the comparison between the two drugs was made from the perspective of anesthesia, Dexmedetomidine proved more effectiveness during endoscopy, as the degree of anesthesia that the patient reaches through Dexmedetomidine gives the patient the ability to respond to commands such as moving to the right or left [ 27 – 29 ]. In addition to the side effects that occur during anesthesia, complications during endoscopic operations were more minor when using Dexmedetomidine, the most important of which are respiratory failure and the need for pulmonary intubation, therefore, the benefits gained from Dexmedetomidine exceed that of Midazolam during endoscopy [ 30 ]. The optimum technique to reduce pain and provide an adequate amount of sedation via endoscopy is still being debated and researched [ 13 ]. There are numerous contraindications to using Midazolam, such as hypotension, acute angle-closure glaucoma, and deffrent types shocks [ 31 ]. Adjusting the dosage of the medication should be done with caution in the patients with liver and kidney disease, drug-dependent and alcohol-dependent individuals, pregnant women, comorbid psychiatric problems, and children, to avoid the accumulation of Midazolam active metabolites in severely ill and elderly patients, administration should be done with caution [ 32 ]. Patients with renal failure and those using opioids, clarithromycin, erythromycin, sertraline, diltiazem, alcohol, protease inhibitors, antipsychotics, phenobarbital, rifampin, phenytoin, and carbamazepine should be administered with caution, furthermore, grapefruit juice boosts drug activity by inhibiting the CYP450 enzyme, but St. plant lowers drug impact by activating the CYP450 enzyme [ 33 ]. Midazolam toxicity is uncommon but can occur when combined with central nervous system depressants such as tricyclic antidepressants, opioids, and alcohol. In elderly patients, intravenous administration increased the risk, particularly in patients with chronic obstructive pulmonary disease. Furthermore, the role of sedation in endoscopy is important to promote patient's participation throughout the process; however, there is less evidence on the effects of Dexmedetomidine in upper endoscopy [ 9 – 11 ]. A review of studies that found Dexmedetomidine superior in analgesia, reliability, and patient and provider satisfaction, with both drugs showing similar safety profiles for respiratory and circulatory systems when dosed accurately [ 34 ]. In a meta-analysis of nine studies involving 657 patients, Dexmedetomidine was linked to fewer side effects, with no significant differences in oxygen saturation or mean arterial pressure between the drugs [ 21 ]. One protocol administered 0.3 mcg/kg Dexmedetomidine and 1 mcg/kg Fentanyl ten minutes before endoscopy, resulting in higher satisfaction and oxygen levels compared to the Midazolam group, which used a similar protocol [ 1 , 35 ]. Another study reported that Dexmedetomidine caused fewer side effects, like retching, and greater provider satisfaction compared to Midazolam, which used a 0.07 mg/kg dose with lidocaine throat spray [ 7 ]. In ERCP studies, Dexmedetomidine was preferred due to lower oxygen desaturation and faster recovery compared to Midazolam [ 36 ] [ 20 , 37 ]. In patients aged 18–80, Dexmedetomidine protocols showed similar sedation levels as Midazolam but with fewer side effects like nausea, coughing, and gagging, as well as higher endoscopist satisfaction [ 38 ]. A systematic review and meta-analysis by Soleimanpour et al. (2019) assessed the role of Dex in patients with liver disease. The review included seven studies with a total of 218 patients, focusing on its effects post-liver transplantation and in hepatic dysfunction. The findings indicated that lower doses of Dex could have protective effects on liver tissue, while higher doses (10 µg/kg) might be detrimental. Specifically, Dex administration was associated with reduced hepatic ischemia-reperfusion injury (IRI) and improved liver function tests post-surgery [ 39 , 40 ]. However, the study noted that the mean arterial pressure (MAP) changes in the intervention group were not statistically significant compared to controls, suggesting a need for careful dosage management[ 39 ]. In another study by Asri et al. (2020), the effects of Dex combined with inhalation of isoflurane on oxygenation during one-lung ventilation in thoracic surgery were evaluated. The study highlighted that Dex could enhance oxygenation levels postoperatively, indicating its potential benefits in managing respiratory function during complex surgical procedures [ 41 , 42 ]. This aligns with findings from other studies suggesting that Dex may help stabilize hemodynamics and reduce the need for opioids during surgery [ 43 ]. Ghojazadeh et al. (2022) conducted a systematic review on the use of Dex for procedural sedation in emergency departments [ 44 ]. This review emphasized its efficacy in providing sedation with a favorable safety profile compared to traditional sedatives. The analysis pointed out that Dex could lead to lower rates of respiratory depression and shorter recovery times, making it a valuable option for emergency settings [ 41 ]. Mahmoodpoor et al. (2020) discussed the use of Dex as an all-in-one sedation drug for critically ill patients with COVID-19 [ 45 ]. The study underscored its utility in managing sedation while minimizing opioid use, which is particularly important given the respiratory complications associated with COVID-19 [ 41 ]. The findings suggest that Dex may help improve patient outcomes by providing effective sedation without exacerbating respiratory issues. A significant knowledge gap exists in the use of dexmedetomidine for upper endoscopy sedation, particularly regarding its long-term safety, cost-effectiveness, and standardization of dosages across diverse patient populations. While studies have shown dexmedetomidine to be as effective and safe as midazolam and propofol, with benefits such as reduced gagging and hypoxia risk, there is a need for more comprehensive comparative studies with other sedatives like ketamine combinations [ 46 – 48 ]. Additionally, research on the impact of cultural and socioeconomic factors on patient preferences and outcomes related to dexmedetomidine sedation is lacking. In regions like Palestine, local clinical trials and studies on accessibility and training for healthcare providers are essential to tailor sedation practices to local needs and infrastructure. Addressing these gaps could enhance the safe and effective use of dexmedetomidine in upper endoscopy worldwide. There has been minimal research on the use of Dexmedetomidine in endoscopy, both globally and within Palestine, despite its proven usefulness, efficacy, and safety across various medical applications [ 49 ]. The aim of this study is to compare the efficacy and safety of Midazolam and Dexmedetomidine for sedation during upper endoscopy, focusing on respiratory and hemodynamic stability, sedation quality, recovery time, and patient and endoscopist satisfaction. Primary outcomes include changes in vital signs, sedation level, time to sedation, recovery time, and need for additional doses. Secondary outcomes assess patient and endoscopist satisfaction, including anxiety, discomfort, gagging, and technical difficulty. The study aims to identify a safer, more effective sedative with minimal adverse effects. Methods Study Design This study follows a prospective, observational design aimed at comparing two sedation interventions for patients undergoing elective upper endoscopy. Two groups of patients were observed: one group received the sedative Dexmedetomidine, while the other was administered Midazolam. Both groups underwent a pre-test assessment to establish baseline data before the intervention. Post-intervention, outcomes were measured using a post-test assessment to evaluate the efficacy and safety of each sedative in achieving the desired sedation level, maintaining patient comfort, and minimizing complications. The same endoscopist performed all procedures to maintain consistency in technique, while the anesthesiologist, who was not involved in the research data analysis, conducted the sedation to reduce bias. Study Setting and Site The study was conducted in the Endoscopic Department at An-Najah National University Hospital, located in Nablus, Palestine. The department serves a range of patients undergoing diagnostic and therapeutic endoscopic procedures. All procedures followed standard protocols established by the hospital’s endoscopy team and took place in a clinical environment with access to emergency equipment, ensuring patient safety throughout the study. Study Population The study population consisted of adult outpatients scheduled for elective upper endoscopy procedures at An-Najah National University Hospital. An-Najah National University Hospital is a general hospital in Nablus, Palestine, established in 2013. It's a non-profit teaching hospital affiliated with An-Najah National University. The hospital started with 127 beds, with plans to expand to nearly 500 but now with 135 bed. It has various departments like Surgery, Internal Medicine, Pediatrics, Anesthesia, and Radiology. It's a private institution and a referral center, serving patients from the West Bank and Gaza Strip.Inclusion criteria focused on patients aged 18 to 60 with American Society of Anesthesiologists (ASA) physical status classifications of I or II, indicating patients with no or mild systemic disease. Data collection took place from October 2021 to January 2022. The study received ethical approval from the Institutional Review Board (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. Written informed consent was obtained from each participant, and confidentiality, autonomy, and the right to withdraw were assured throughout the study. Inclusion and Exclusion Criteria Inclusion criteria included patients aged 18–60 with ASA physical status I or II. Exclusion This study included patients aged 18 to 60 years who were classified as ASA (American Society of Anesthesiologists) physical status I or II and scheduled for elective upper gastrointestinal endoscopy. Patients with severe systemic diseases, classified as ASA III or higher, were excluded. Additionally, individuals with known allergies to Dexmedetomidine, Midazolam, or any of the medications used in the study protocol were not eligible to participate. Pregnant or lactating women, patients with psychiatric disorders, or those unable to provide informed consent were also excluded. The study further excluded individuals currently taking medications known to interact with the study drugs, such as central nervous system depressants, and those with a history of substance or alcohol abuse. Finally, any patients with contraindications to sedation or endoscopic procedures were excluded from participation. A total of 68 patients met the inclusion criteria and were enrolled in the study, with no exclusions following the initial screening process. Sampling and Sample Size Calculation A sample size calculation was performed based on an expected difference in satisfaction and sedation efficacy between the two drugs, using a type I error (α) of 0.05 and a type II error (β) of 0.20 to ensure an 80% power to detect statistical significance. Based on prior studies, it was anticipated that patients receiving Dexmedetomidine would report a higher satisfaction rate (90%) compared to those receiving Midazolam (55%). Using an online sample size calculator for two-proportion testing, it was determined that each group required 34 participants, totaling 68 patients, after accounting for a potential 10% dropout rate. Randomization Patients were randomly assigned to either the dexmedetomidine or midazolam group using a computer-generated randomization sequence. To reduce selection bias, the sequence was generated independently by a researcher not involved in the clinical procedures or data analysis. Although the study was not blinded, all data collection and analysis were performed objectively using predefined criteria Data Collection Tools and Procedure Data was systematically gathered using three structured tools to ensure a comprehensive and reliable approach (Appendix A). First, a Sociodemographic Data Sheet was used to document each patient’s initials, case number, age, gender, height, weight, BMI, substance use history, education level, and the reason for undergoing endoscopy (such as dysphagia, esophageal reflux, or dyspepsia). This information provided essential background on each participant, supporting the analysis of how these factors might influence sedation and recovery. In addition, a Sedation and Recovery Times record was maintained for each patient, capturing the time needed to achieve full sedation (defined as a Ramsay Sedation Scale [RSS] score of ≤4), the time to reach recovery (RSS score of 2), and the overall duration of the endoscopic procedure. Post-procedure recovery was tracked at specified intervals of 15, 30, and 45 minutes to ensure a thorough assessment of each sedative’s effectiveness and safety. Finally, a Follow-up Observation Sheet was designed to monitor sedation depth and the physiological responses of each patient at key time points throughout the procedure. Observations were recorded before sedation (baseline), immediately before endoscopy initiation (aiming for RSS 3-4), five minutes into the endoscopy or upon any significant changes, and one hour post-endoscopy to identify any delayed adverse effects. This sheet documented vital signs and side effects such as bradycardia, tachycardia, hypotension, hypertension, respiratory issues, and any signs of patient discomfort, allowing a continuous assessment of patient safety. The datasheet’s validity was ensured through a review process involving a panel of experts that included two anesthesiologists, an academic with specialization in nurse anesthesia, an anesthesia nurse, and a statistician. Their input helped ensure the tool’s alignment with both clinical and research standards. Data Collection Process The data collection process spanned three main phases: pre-procedure, during the procedure, and post-procedure (Fig. 1). Pre-Procedure: Each patient was briefed on the study objectives and procedure, after which they signed a consent form. Baseline data, including vital signs and American Society of Anesthesiologists (ASA) classification, were recorded to establish a starting point for comparison. To ensure safety, an emergency resuscitation cart was prepared. Each patient was also advised to have a responsible adult accompany them home, as the effects of sedation could temporarily impair alertness. During the Procedure: Patients were positioned in the left lateral position, with continuous monitoring of blood pressure, pulse oximetry, and heart rate throughout the procedure. Sedation was administered according to the group assignment: In the Dexmedetomidine group, each patient received 0.3 mcg/kg of Dexmedetomidine combined with 1 mcg/kg of Fentanyl intravenously, ten minutes before the procedure, followed by a continuous Dexmedetomidine infusion. In the Midazolam group, each patient received 0.05 mg/kg of Midazolam and 1 mcg/kg of Fentanyl intravenously, with additional doses of Midazolam administered every 2–5 minutes as needed to achieve the desired sedation level. The Ramsay Sedation Scale (RSS) was used to assess sedation depth during the procedure, aiming for an RSS score 4 or more. Post-Procedure: Following the endoscopy, patients were closely monitored until they achieved a full recovery, indicated by an RSS score of 2. Discharge readiness was assessed using the Post-Anesthesia Recovery Scoring System (PARS). Patients were informed of possible post-procedure effects, such as mild throat soreness, and advised to avoid activities requiring full alertness until they were fully recovered. Patient and endoscopy specialist satisfaction were assessed using a structured 1 to 10 scale, ranging from "very dissatisfied" to "very satisfied." Patient satisfaction evaluation covered aspects such as anxiety, gagging, discomfort, and overall satisfaction, while endoscopy specialist satisfaction included technical difficulty, satisfaction with the patient’s sedation level, and observations of patient discomfort, retching, and gagging. Ethical Considerations This study was conducted with IRB approval from An-Najah National University and in compliance with the Declaration of Helsinki. All participants received information about the study’s objectives, methods, and potential risks. Written consent was obtained, and participants retained the right to withdraw at any stage. Patient confidentiality was protected, and all data was securely stored and anonymized during analysis. Participants were informed that sedation was used for their comfort and that an experienced endoscopist and anesthesiologist would monitor the procedure to ensure safety. Data Analysis Data analysis was performed using SPSS software version 20. Continuous variables were summarized as means and standard deviations, while categorical data were presented as counts and percentages. Statistical tests, such as the t-test for continuous variables and chi-square for categorical variables, were conducted to assess differences between the two groups. Statistical significance was set at p < 0.05. Results This study aimed to compare the Midazolam and Dexmedetomidine used for upper endoscopy performed under sedation, The primary outcome: vital signs changes, including mean arterial pressure, oxygen saturation , respiration rate, and heart rate of the patients and Ramsay sedation scale (RSS), time to full sedation, time to full recovery, an additive dose of any sedative or analgesic drug and if using of any drug to treat any side effect during the procedure. Secondary outcomes included: patient and endoscopy specialist satisfaction and adverse effects, regarding patient: anxiety, gagging, discomfort, and satisfaction, regarding endoscopy specialist: technical difficulty, satisfaction with the patient’s sedation level, patient discomfort, patient retching, and patient gagging. Demographic Data of patients in Midazolam and Dexmedetomidine group s The study recruited 68 patients, who were randomly assigned to receive either Midazolam or Dexmedetomidine (n=34/group). Demographic and clinical data of the patients are shown in Table 1. There were no statistically significant differences between groups in sex distribution, age, BMI, smoking distribution and education level. While there was a significant difference in endoscopy duration between the two groups, Dexmedetomidine required 11.0 ± 1.9 minutes and Midazolam required 9.9 ± 1.5 minutes, p=0.008. 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 *Mean ± SD Indications for endoscopy in Midazolam and Dexmedetomidine groups When it came to endoscopic indications, there was a significant difference between the groups. When it came to dysphagia: 12/34 (35.3%) patients in the Midazolam group and 17/34 (50%) patients in the Dexmedetomidine group, p=0.032. There were also significant differences between the groups in terms of esophageal reflux, with 17/34 (50%) patients in the Midazolam group and 7/34 (20.5) patients in the Dexmedetomidine group, respectively, p=0.035. As well as significant differences in Dyspepsia across the groups 5/34 (14.7%) patients in the Midazolam group and 10/34 (29.4%) patients in the Dexmedetomidine group, p=0.031.(Table 2). Table 2 Indications for endoscopy in Midazolam and Dexmedetomidine groups Variable Midazolam group (n=34) Dexmedetomidine group (n=34) p Dysphagia% 35.29% 50% 0.032 Esophageal reflux symptoms% 50% 20.59% 0.035 Dyspepsia% 14.70% 29.41% 0.031 Data presented as n(%) Pre-procedural expected patient satisfaction Expected patient satisfaction before receiving Midazolam or Dexmedetomidine is not significantly different between the two groups for Satisfaction and discomfort (p >.05), but there is a significant difference between groups for gagging and anxiety. Mean gagging for Midazolam is lower than Dexmedetomidine 1.0± 1.1versus 1.6 ±1.1, p=0.020), and mean anxiety for Midazolam is higher than Dexmedetomidine, 2.6 ± 0.9 versus 2.1 ± 1.4, p=0.018 (Table 3). Table 3 Pre-procedural expected patient satisfaction, discomfort, gagging and anxiety score. Data presents as mean (± SD) Variable Midazolam group (n=34) Dexmedetomidine group (n=34) p 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-procedural patient satisfaction Table 4 shows the patient satisfaction after receiving Midazolam or Dexmedetomidine. Except for the gagging score, there are significant variations between the two groups in terms of satisfaction, discomfort, and anxiety (Table 4). There was a significant difference in satisfaction between the Dexmedetomidine group (9.1 ± 1.0) and the Midazolam group (8.06 ± 0.9), p=0.001. There was a significant difference in discomfort between the Dexmedetomidine group (0.7 ± 0.9) and the Midazolam group (1.7 ± 1.1), p=0.001. There was a substantial difference in anxiety between the Dexmedetomidine group 0.5 ± 0.8 and the Midazolam group 1.8 ± 1.4, p=0.001. When compared to the Midazolam group, the Dexmedetomidine group demonstrated much higher satisfaction, less discomfort, and less anxiety (Fig. 2). Table 4 Post-procedural patient satisfaction, discomfort, gagging and anxiety score. Data presents as mean (± SD) Variable Midazolam group (n=34) Dexmedetomidine group (n=34) p Satisfaction (0-10 score) 8.06 ± 0.9 9.1 ± 1.0 0.001 Discomfort (0-10 score) 1.7 ± 1.1 0.7 ± 0.9 0.001 Gagging (0-10 score) 0.7 ± 0.9 0.6 ± 1.5 0.077 Anxiety (0-10 score) 1.8 ± 1.4 0.5 ± 0.8 0.001 Endoscopy specialist satisfaction Patients receiving Dexmedetomidine had significantly better endoscopic specialist satisfaction than those receiving Midazolam (8.7±1.6 versus 8.2±1.0); P=0.001. Respectively. Patients taking Dexmedetomidine had significantly less discomfort than those receiving Midazolam (1.0 ± 1.4versus 1.8 ± 0.9); p=0.037. Patients taking Dexmedetomidine had considerably less gagging than those receiving Midazolam (0.8 ± 1.3versus 1.0 ± 0.8; p=0.036). Also Patients taking Dexmedetomidine had considerably less retching than those receiving Midazolam (0.5±1.1 versus 0.6±0.6; P0.013) (Table 5). There was a significant difference in technical difficulty between the Dexmedetomidine and Midazolam groups, with the Dexmedetomidine group scoring 1.1 ± 1.1vs the Midazolam group scoring 1.6 ± 0.8, p=0.035. In all facets of endoscopic specialist, the Dexmedetomidine group outperformed the Midazolam group (Fig. 3). Table 5 Endoscopy specialist satisfaction, discomfort, gagging, retching, and technical difficulty. Data reported as Mean (± SD) Variable Midazolam group (n=34) Dexmedetomidine group (n=34) p Satisfaction 8.2 ± 1.0 8.7 ± 1.6 0.001 Discomfort 1.8 ± 0.9 1.0 ± 1.4 0.037 gagging 1.0 ± 0.8 0.8 ± 1.3 0.036 Retching 0.6 ± 0.6 0.5 ± 1.1 0.013 Technical difficulty 1.6 ± 0.8 1.1 ± 1.1 0.035 Recovery data in Midazolam and Dexmedetomidine groups In table 6 for average recovery, 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). Table 6 Recovery data in Midazolam and Dexmedetomidine groups. Variable Midazolam group (n=34) Dexmedetomidine group (n=34) p Time min RSS 4 2.4 ± 7.7 9.5 ± 1.1 0.001 Time min RSS =2 48.8 ± 6.0 18.0 ± 5.2 0.001 Patients fully recovered, n (%) 15 Min 0 17 (50%) 0.001 30 Min 0 17 (50%) 0.001 45 Min 34 (100%) 0 0.001 Data presented as Mean (±SD) and as n (%) Adverse effect Regarding side effect, Table 7 represent the most side effect after receiving Midazolam or Dexmedetomidine, While assessing the following side effects, which are: hypertension, hypotension, tachycardia, bradycardia, hypoxia, tachypnea, bradypnea, apnea, coughing, vomiting, retching, nausea, allergies, and abnormal body movements. The most frequent side effect was hypertension for both groups. It was found that the occurrence of side effects in the Dexmedetomidine group was less than in the Midazolam group but it was not significant. Table 7 Adverse effects in Midazolam and Dexmedetomidine groups Variable Midazolam group (n=34) Dexmedetomidine group (n=34) p-value Bradycardia% 8.82% 0% 0.076 Hypertension% 17.64% 17.64% 0.493 Coughing% 8.82% 2.94% 0.303 Tachycardia% 5.88% 0% 0.151 Nausea% 2.94% 0% 0.314 Hypotention% 0% 0% * Vital signs of the patients in both Midazolam and Dexmedetomidine groups Regarding vital signs, there is no significant difference between the Midazolam group and the Dexmedetomidine group, except for respiratory rate, Dexmedetomidine group has less rate compared to the Midazolam group 16.7 ± 1.9, 18.6 ± 4.7 respectively, p=0.028. Tables 8 to 12 provide an overview of the vital signs measured at four time points for patients in the Midazolam and Dexmedetomidine groups. Table 8 presents the overall vital signs, including Mean Arterial Pressure (MAP), Heart Rate (HR), Oxygen Saturation (SpO2), and Respiratory Rate (RR). The results showed no significant differences between the two groups for MAP, HR, and SpO2 at any of the time points. However, a significant difference was found in Respiratory Rate, where the Dexmedetomidine group consistently had lower rates compared to the Midazolam group . Tabe 8 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) Table 9 focuses specifically on MAP at the four points, showing no significant differences between the groups at any of the time points (p > 0.05). Tabe 9 MAP in both Midazolam and Dexmedetomidine groups Variable Midazolam group (n=34) Dexmedetomidine group (n=34) p Point 1 92.7 ± 11.4 92.7 ± 10.5 0.896 Point 2 91.3 ± 7.8 95.9 ± 13.8 0.311 Point 3 89.7 ± 10.2 90.2 ± 8.7 0.777 Point 4 88.7 ± 9.6 88.4 ± 11.3 0.658 Data displayed as Mean (± SD) Table 10 displays the Heart Rate (HR) at each point, with no significant differences at points 1, 2, and 4. However, at point 3, there was a significant difference (p = 0.049), with the Dexmedetomidine group showing a lower HR compared to the Midazolam group . Tabe 10 HR in both Midazolam and Dexmedetomidine groups Variable Midazolam group (n=34) Dexmedetomidine group (n=34) p Point 1 80.91 ± 16.58 80.18 ± 13.52 0.654 Point 2 81.03 ± 13.20 77.977± 15.64 0.353 Point 3 80.82 ± 14.24 75.74± 13.75 0.049 Point 4 78.8 ± 12.13 74.79 ± 11.41 0.163 Data displayed as Mean (± SD) Table 11 presents SpO2 measurements, where no significant differences were observed at any time point (p > 0.05). Tabe 11 SpO2 in both Midazolam and Dexmedetomidine groups Variable Midazolam group (n=34) Dexmedetomidine group (n=34) p Point 1 97.65 ± 1.64 98.65 ± 2.56 0.063 Point 2 97.59 ± 1.74 97.50 ± 2.50 0.970 Point 3 97.24 ± 1.89 97.09 ± 2.77 0.975 Point 4 97.29 ± 1.60 96.97 ± 3.43 0.797 Finally, Table 12 highlights Respiratory Rate (RR) at the four points. Significant differences were observed at points 3 and 4, with the Dexmedetomidine group showing significantly lower RR at both time points (p = 0.004 at point 3 and p = 0.001 at point 4) compared to the Midazolam group. Tabe 12 RR in both Midazolam and Dexmedetomidine groups Variable Midazolam group (n=34) Dexmedetomidine group (n=34) p Point 1 17.74 ± 0.71 16.53 ± 2.56 0.063 Point 2 17.59 ± 0.92 17.00 ± 2.53 0.970 Point 3 17.38 ± 0.98 15.82 ± 2.40 0.004 Point 4 20.38 ± 0.84 16.06 ± 2.55 0.001 Data displayed as Mean (± SD) Discussion The result of the current study proved the efficacy and safety of using Dexmedetomidine and its superiority to Midazolam in many aspects, such as patient satisfaction, endoscopy specialists’ satisfaction, stability of vital signs, and the lack of side effects, as well as the speed of recovery after procedure, which reduces the patient’s stay in the hospital and increases the occupancy rate of the department to provide places for patients in a way faster. The importance of this research stems from the large number of side effects expected from the drug Midazolam, these findings are consistent with those of other research that have been published which were shown that the concomitant use of Midazolam with analgesia drugs increases the risk of respiratory and circulatory failure in patients [ 50 ] Bartolomé et al., 2007) [ 51 , 52 ], its toxicity, its conflict with many drugs, and the many caveats with many pathological conditions [ 32 , 33 ] Add to that the length of the patient's stay in recovery departments, which reduces the possibility of receiving other cases [ 36 , 37 ]. As a result, there was a need to look for a safe and effective alternative to meet the endoscopic anesthetic need. During this research, Midazolam and Dexmedetomidine were compared in upper endoscopy only, and the drug Fentanyl was used as analgesia, as many researches [ 35 , 37 ]. But in other research, Remifentanil was used as an analgesia [ 36 ], another used topical lidocaine [ 7 ], Others, on the other hand, did not utilize analgesics and instead focused on treating pain with the effects that each of the two medications has on patients [ 20 , 38 ]. The ratio of males to females in this study was randomly 1:1, While in other studies, the percentage of males was more than female, percentage was as follows 62% [ 38 ], 55% [ 35 ] and 52% [ 36 ]. On the contrary, the percentage of males was lower in other studies, and their percentage was as follows 44% [ 7 ], 46% [ 20 ] and 45% [ 37 ]. There are significant difference between two groups for all binoculars of patient satisfactions except gagging score, Dexmedetomidine group showed higher satisfaction, less discomfort and less anxiety compared to Midazolam group.In Demiraran and his colleges research, both gropes showed satisfactory and similar results in terms of anxiety, discomfort and gagging, as well as patient satisfaction [ 7 ]. In another study for the gagging assessment, more occurrence were observed in the Midazolam group than in the Dexmedetomidine group [ 38 ]. And in a systematic review study for 12articles including 883 patients, the superiority and merit of Dexmedetomidine over Midazolam was shown in patient satisfaction [ 34 ]. Also in a meta-analysis for 9 eligible randomized controlled trials included 657 patients, the superiority of Dexmedetomidine was shown in patient satisfaction aspect over Midazolam [ 21 ]. In a retrospective randomized study for 60 adult patients, the satisfaction in the Dexmedetomidine group was higher, [ 35 ]. The results in terms of patient satisfaction were preferable to the Dexmedetomidine group in a Prospective, randomized, single-blinded preliminary trial including 198 patients [ 36 ].Finally, the satisfaction of patients was the highest in the Dexmedetomidine group in a randomized controlled trial for 60 patients [ 37 ]. The endoscopy specialist rating for all satisfaction aspects was significant difference between two groups, for patient satisfaction significantly higher in the patients receiving Dexmedetomidine than those receiving Midazolam (87.8 ± 1.6 versus 8.2 ± 1.0; P = 0.001). Retching was significantly lower in patients receiving Dexmedetomidine compared with those receiving Midazolam (0.5 ± 1.1 versus 0.6 ± 0.6; P < 0.001). Dexmedetomidine group showed better than Midazolam group in all Visual analog scale (VAS) score. This was in line with many studies that support the superiority of Dexmedetmomidine over Midazolam in the context of specialist satisfaction, and this was demonstrated by Barends and colleagues in the Systemic Review Study, which was conducted in 2017 [ 34 ]. In another study, the endoscopy was performed by the same specialist, and the scale was weighed in favor of Dexmedetomidine in the context of the specialists’ satisfaction, where several criteria were considered, which are the patient's discomfort from the specialist's point of view, satisfaction with the patient's sedation, technical problems, gagging and retching [ 7 ]. In another study, to examine the specialists’ satisfaction with using criteria from one to four, where one is poor, followed by Fair, then Good, and then Excellent, the superiority of Dexmedetemomidine over the other drug was shown through this scope [ 37 ]. In another study, a tool with two options, either satisfied or very satisfied, was used to assess the specialist’s satisfaction, and the results showed similar results to the previous one with the superiority of Dexmedetomidine [ 38 ]. In the research conducted by Zhiqiang Lu and his colleagues in a study that included 198 patients, it was found that the specialist’s satisfaction in the Dexmedetomidine group is not different from his satisfaction in the Midazolam group. A scale of one to six was used to assess their satisfaction, with six being very satisfactory [ 36 ]. For average recovery, Dexmedetomidine patients were recovered faster than Midazolam patients, 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. One of the studies that used a mechanism to assess the time required to recover from sedation, as the time was calculated from the moment the procedure ended until reaching modified ramsay sedation score 2, it showed that the duration of recovery in the Dexmedetomidine group is shorter than in the Midzolam group, but the difference does not constitute a statistical difference [ 36 ]. Further research showed that ninety percent of the Dexmedetomidine group achieved a Modified Aldrete score of nine or more within five minutes of completing the procedure, while seventeen percent of the Midazolam group showed the same result after the same period and the difference was statistically different [ 37 ]. Regarding to vital signs, there are no significant difference between Midazolam group and Dexmedetomidine group, except respiratory rate, Dexmedetomidine group has less rate compared to Midazolam group 16.7 ± 1.9, 18.6 ± 4.7 respectively. In a review of a group of studies examining the safety of Dexmedetomidine on the respiratory system compared to Midazolam, it was found that twenty cases of hypoxemia occurred in the Dexmedetomidine group compared to twenty-four cases. So that this research included an analysis of evidence for seven hundred and sixty-seven cases, and this difference was not statistically significant, while both showed safety in terms of affecting the circulatory system in the same research, so that during the analysis of the data, the striking results were those that were mentioned in eight studies, where there was a drop in blood pressure for ten patients in the Dexmedetomidine group compared to seven patients in the Midazolam group and this difference is not statistically different, and two of the studies that were analyzed showed the emergence of some cases of high blood pressure in the Midazolam group(Barends et al., 2017).In analyzing the results of five studies with no significant heterogeneity in data, it was found that there is no difference between the two drugs in the effect on the concentration of oxygen in the blood, the results of six studies with no significant heterogeneity in datashowed that there was no difference in the effect between the two drugs on the mean arterial pressure [ 21 ]. In the research conducted by Wei Wu and his colleagues the preference for the Dexmedetomidine group in terms of the mean arterial pressure reading was lower in the Midazolam group, the blood oxygen concentration was more high in the Dexmedetomidine group [ 35 ]. In another studythe results showed the following that blood oxygen saturation, mean arterial pressure, heart rate and respiratory rate were similar in the two groups [ 7 ]. While the Midazolam group showed a higher incidence of decreased blood oxygen concentration than the other group [ 36 ]. The results in terms of safety, there were low incidence of cases of low blood oxygen concentration in the Dexmedetomidine group, and also in the Dexmedetomidine group the median of the Midazolam dose used was lower; In addition to this, the systolic blood pressure reading and heart rate decreased in the Dexmedetomidine group, but no complications that led to heart failure or irregular heartbeats [ 20 ]. Further research showed that in the Dexmedetomidine group, there was a decrease in heart rate, while there was no significant difference in the reading of blood pressure and respiratory rate [ 37 ]. In the research conducted by Kilic and his colleagues the results showed a lower heart rate in the Dexmedetomidine group, in terms of respiratory rate and MAP the results were similar [ 38 ]. While assessing the following side effects, which are: hypertension, hypotension, tachycardia, bradycardia, hypoxia, tachypnea, bradypnea, apnea, coughing, vomiting, retching, nausea, allergies and abnormal body movements. The most important and most frequent side effect was hypertension for both groups.Eighteen times side effects occurred in the Midazolam group, and they were in the following numbers in each symptom: three in bradycardia, six in hypertension, three in coughing, three in hypoxia, two in tachycardia, one in nausea. Compared to the Dexmedetomidine group, in which five times side effects occurred, four of which were in hypertension and one in coughing. It was found that the occurrence of side effects in the Dexmedetomidine group was less than in the Midazolamgroup.In another study, as for the side effects, only four studies dealt with this matter, and they looked at the following side effects, which are: nausea and vomiting, respiratory depression, dysphoria, dizziness, reflux, pain and abdominal distention, It was found that the occurrence of side effects in the Dexmedetomidine group was less than in the Midazolam group [ 21 ]. But in another study the results showed that there are no clinically significant complications in the two groups, and that the use of Dexmedetomidine is safe and effective in upper endoscopy [ 35 ]. While the preferential results of Dexmedetomidine were shown in several aspects, namely, fewer side effects compared to Midazolam, less retching, and a significant increase in specialist satisfaction [ 7 ]. In another study Dexmedetomidine showed less nausea reaction than in the Midazolam group during endoscopy [ 36 ]. Inatomi and his colleagues conclude that, it is no complications that led to heart failure or irregular heartbeats [ 20 ]. In gaging assessment Sethi conclude that the appearance of the gag ​​reaction was more in the Midazolam group than in the Dexmedetomidine group [ 37 ]. Finally Killic and his colleagues conclude that regarding to side effects, nausea, vomiting, and coughing were observed in the Midazolam group, with none in the Dexmedetomidine group [ 38 ]. This study provides evidence that Dexmedetomidine offers superior patient and provider satisfaction with faster recovery and fewer side effects compared to Midazolam. These findings support its consideration as a safer and more effective sedative for upper endoscopy, potentially changing clinical practices and enhancing patient outcomes Conclusion Dexmedetomidine demonstrated superior performance over Midazolam for sedation during upper endoscopy, offering significantly faster recovery times, higher patient satisfaction, and greater satisfaction from endoscopists. Additionally, it reduced discomfort, anxiety, and retching, with fewer side effects and no significant difference in vital signs compared to Midazolam. Given these advantages, Dexmedetomidine is a promising alternative sedative for upper endoscopy. Limitations This study has several limitations that should be considered when interpreting the results. First, it was conducted at a single-center, which may limit the generalizability of the findings to other settings and populations. Second, the relatively small sample size of 68 patients might reduce the statistical power and robustness of the results. Third, the study did not include long-term follow-up to evaluate the sustained effects of Dexmedetomidine and Midazolam, such as their impact on patient outcomes beyond the immediate recovery period. Additionally, the lack of blinding for patients and providers may have introduced potential bias in subjective outcomes, such as satisfaction ratings. Future research should address these limitations by including multicenter designs, larger sample sizes, and longer follow-up periods to validate and expand upon these findings, the exclusion of propofol in our study limits its generalizability and comparison with the most popular sedation protocols. Abbreviations ASA American Society of Anesthesiologists CYP Cytochromes P ERCP Endoscopic retrograde cholangiopancreatography G Gauge GABA Gamma aminobutyric acid hr Hour ICP intracranial pressure ICU intensive care unit IRB institutional review board IV Intravenous kg kilogram L Litter MAP Mean arterial pressure MAS Modified Aldrete Score mcg Microgramme min Minute PT Prothrombin time PTT Partial thromboplastin time RSS Ramsay Sedation Scale SD Standard deviation SPO2 Oxygen saturation VAS Visual analog scale Declarations Acknowledgements The authors would like to thank An-Najah National University (www.najah.edu) for the technical support provided to publish the present manuscript 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., and A.A. All authors reviewed and approved the final manuscript. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Ethics approval and consent to participate The study received ethical approval from the Institutional Review Board (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. Clinical trial registration This research did not involve a clinical trial; no clinical trial registration is applicable. 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University","correspondingAuthor":false,"prefix":"","firstName":"Aidah","middleName":"","lastName":"Alkaissi","suffix":""},{"id":445275230,"identity":"8324aeff-a07f-487d-b5c5-55c5e9e33fb7","order_by":2,"name":"Wael Sadaqa","email":"","orcid":"","institution":"An-Najah National University","correspondingAuthor":false,"prefix":"","firstName":"Wael","middleName":"","lastName":"Sadaqa","suffix":""},{"id":445275231,"identity":"fc0135fb-0227-4d3e-bd7d-9f8069ada6e8","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":445275232,"identity":"f5ea1341-d408-4ddc-bbd0-a2d31640a6e3","order_by":4,"name":"Shadi Khilfeh","email":"","orcid":"","institution":"An-Najah National University","correspondingAuthor":false,"prefix":"","firstName":"Shadi","middleName":"","lastName":"Khilfeh","suffix":""},{"id":445275233,"identity":"f208b3a2-2aaa-48e9-9bf2-e9b8fa7b352f","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":445275235,"identity":"1070749b-1179-4117-a322-2eac5bf7920b","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":445275237,"identity":"b9b3c32d-e0a2-40e3-9caf-f5692765b731","order_by":7,"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":"2025-03-19 12:38:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6261635/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6261635/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82131234,"identity":"69b94c70-d7b9-45ba-aeee-9d22e0710ece","added_by":"auto","created_at":"2025-05-07 05:34:47","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-6261635/v1/c580eece1058b7b67a0eaf6c.png"},{"id":82134869,"identity":"1b75a74e-d5ee-4244-a396-87532b8b317a","added_by":"auto","created_at":"2025-05-07 06:06:47","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":44072,"visible":true,"origin":"","legend":"\u003cp\u003epatients perseptions\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6261635/v1/9293f93e96340bb944d75988.png"},{"id":82131228,"identity":"0569e84d-1745-48e6-b83a-dc6d96962c71","added_by":"auto","created_at":"2025-05-07 05:34:47","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":47467,"visible":true,"origin":"","legend":"\u003cp\u003eEndoscopy spicialist perseption\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6261635/v1/e2832afe34a21d713a0d36c6.png"},{"id":82134870,"identity":"5a11d790-c623-41ac-a8f1-b459b1f6969b","added_by":"auto","created_at":"2025-05-07 06:06:47","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":27373,"visible":true,"origin":"","legend":"\u003cp\u003eRecovery data in Midazolam and Dexmedetomidine groups.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6261635/v1/0b706700dfe587a8271ef82b.png"},{"id":82131233,"identity":"31d74c35-da94-4c14-8d4a-7b07419833fa","added_by":"auto","created_at":"2025-05-07 05:34:47","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":29244,"visible":true,"origin":"","legend":"\u003cp\u003epatients fully rcovered time per min\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6261635/v1/86686599e62881bd42d12692.png"},{"id":82134878,"identity":"1a4ddcfa-faf8-4668-b613-aaf88e8dbc7a","added_by":"auto","created_at":"2025-05-07 06:06:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4314450,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6261635/v1/ae411f2f-ac14-4e4b-8867-3f7da712c9c9.pdf"},{"id":82132246,"identity":"ee5e933d-9421-44a4-8b65-35ba53fbc725","added_by":"auto","created_at":"2025-05-07 05:42:47","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":19243,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixADataCollectingSheet.docx","url":"https://assets-eu.researchsquare.com/files/rs-6261635/v1/d2de40e226dcde71df5accd6.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The comparison of dexmedetomidine and midazolam used for sedation of patients undergoing upper gastrointestinal endoscopy","fulltext":[{"header":"Background","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIn conscious sedation, patients can keep their response to pain and verbal stimuli without failing respiratory or cardiovascular function [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This type of sedation merges a benzodiazepine, and opioid and is commonly used in minor surgeries and endoscopy [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Endoscopic procedures are essential for the treatment, diagnosis, and evaluation of many disorders like gastrointestinal tract bleeding, foreign body removal or in some complicated procedures like endoscopic retrograde cholangiopancreatography (ERCP), which uses x-ray guidance to accurately treat and diagnose diseases inside the pancreas, bile ducts, liver, and gallbladder [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. During the procedure, pain, anxiety, fear, and retching may let patients to be uncooperative, and it can induce harmful respiratory and cardiovascular effects [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The endoscope is an irritating and painful procedure performed without analgesia and sedation [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. During endoscopy, patients should be anesthetized to avoid mobility, pain, coughing, gagging, and nausea. So, sufficient analgesia and sedation agents should be given and monitored [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. It is necessary to guarantee that the client's protective reflexes are intact but immobile [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. After this type of anesthesia, the patient can recover his reactions and return home on the same day, this benefits both the patient and the hospital so that the occupancy rate in hospitals is reduced and the hospital can receive more cases per day. Other advantages of this type of sedation over general anesthesia are the speed of recovery, ease of response of the patient to the nurse when he awakens and the increase in his level of satisfaction and comfort [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. While using sedative drugs, the aim is to do analgesia, amnesia, and quick patient recovery to the same level of consciousness before the procedure [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Midazolam is one of the benzodiazepines family with a short duration and rapid onset of action [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. It triggers γ-aminobutyric acid receptors and causes central nervous system depression [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Midazolam was the most common sedative agent used in critical care units [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Dexmedetomidine is an antagonist and highly selective drug that works on alpha 2-adrenoceptor and has sedative, amnestic, sympatholytic, and analgesic properties [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Dexmedetomidine started to be used in the critical care unit in 1998, then in other medical applications [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Dexmedetomidine is a good surrogate to Midazolam in sedation [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. With the increase in the use of Dexmedetomidine, many side effects appeared, such as bradycardia and hypotension [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Beneficent clinical applications of Dexmedetomidine sedation are found in endoscopic procedures and retrograde cholangiopancreatography [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In terms of the respiratory system, compared to Midazolam, Dexmedetomidine has been statistically shown to be more effective, it has a lower effect on oxygen saturation in the blood and more respiratory stability, as it leads to faster recovery, it is recommended to be used as an alternative, especially for people who suffer from respiratory problems [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Regarding the cardiovascular system, the most critical complication of Dexmedetomidine is bradycardia and hypotension [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, other studies found no effect of hypotension or bradycardia. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The slow flow of the drug for ten minutes showed that the drug does not lead to a decrease in blood pressure, the correct preparation and administration of the drug give positive results regarding the safety of the circulatory system [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. However, caution should be exercised while administering this drug to people with slow heartbeat problems or heart block [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. And if the comparison between the two drugs was made from the perspective of anesthesia, Dexmedetomidine proved more effectiveness during endoscopy, as the degree of anesthesia that the patient reaches through Dexmedetomidine gives the patient the ability to respond to commands such as moving to the right or left [\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In addition to the side effects that occur during anesthesia, complications during endoscopic operations were more minor when using Dexmedetomidine, the most important of which are respiratory failure and the need for pulmonary intubation, therefore, the benefits gained from Dexmedetomidine exceed that of Midazolam during endoscopy [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The optimum technique to reduce pain and provide an adequate amount of sedation via endoscopy is still being debated and researched [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThere are numerous contraindications to using Midazolam, such as hypotension, acute angle-closure glaucoma, and deffrent types shocks [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Adjusting the dosage of the medication should be done with caution in the patients with liver and kidney disease, drug-dependent and alcohol-dependent individuals, pregnant women, comorbid psychiatric problems, and children, to avoid the accumulation of Midazolam active metabolites in severely ill and elderly patients, administration should be done with caution [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Patients with renal failure and those using opioids, clarithromycin, erythromycin, sertraline, diltiazem, alcohol, protease inhibitors, antipsychotics, phenobarbital, rifampin, phenytoin, and carbamazepine should be administered with caution, furthermore, grapefruit juice boosts drug activity by inhibiting the CYP450 enzyme, but St. plant lowers drug impact by activating the CYP450 enzyme [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Midazolam toxicity is uncommon but can occur when combined with central nervous system depressants such as tricyclic antidepressants, opioids, and alcohol. In elderly patients, intravenous administration increased the risk, particularly in patients with chronic obstructive pulmonary disease. Furthermore, the role of sedation in endoscopy is important to promote patient's participation throughout the process; however, there is less evidence on the effects of Dexmedetomidine in upper endoscopy [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA review of studies that found Dexmedetomidine superior in analgesia, reliability, and patient and provider satisfaction, with both drugs showing similar safety profiles for respiratory and circulatory systems when dosed accurately [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. In a meta-analysis of nine studies involving 657 patients, Dexmedetomidine was linked to fewer side effects, with no significant differences in oxygen saturation or mean arterial pressure between the drugs [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. One protocol administered 0.3 mcg/kg Dexmedetomidine and 1 mcg/kg Fentanyl ten minutes before endoscopy, resulting in higher satisfaction and oxygen levels compared to the Midazolam group, which used a similar protocol [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Another study reported that Dexmedetomidine caused fewer side effects, like retching, and greater provider satisfaction compared to Midazolam, which used a 0.07 mg/kg dose with lidocaine throat spray [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In ERCP studies, Dexmedetomidine was preferred due to lower oxygen desaturation and faster recovery compared to Midazolam [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. In patients aged 18\u0026ndash;80, Dexmedetomidine protocols showed similar sedation levels as Midazolam but with fewer side effects like nausea, coughing, and gagging, as well as higher endoscopist satisfaction [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA systematic review and meta-analysis by Soleimanpour et al. (2019) assessed the role of Dex in patients with liver disease. The review included seven studies with a total of 218 patients, focusing on its effects post-liver transplantation and in hepatic dysfunction. The findings indicated that lower doses of Dex could have protective effects on liver tissue, while higher doses (10 \u0026micro;g/kg) might be detrimental. Specifically, Dex administration was associated with reduced hepatic ischemia-reperfusion injury (IRI) and improved liver function tests post-surgery [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. However, the study noted that the mean arterial pressure (MAP) changes in the intervention group were not statistically significant compared to controls, suggesting a need for careful dosage management[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In another study by Asri et al. (2020), the effects of Dex combined with inhalation of isoflurane on oxygenation during one-lung ventilation in thoracic surgery were evaluated. The study highlighted that Dex could enhance oxygenation levels postoperatively, indicating its potential benefits in managing respiratory function during complex surgical procedures [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. This aligns with findings from other studies suggesting that Dex may help stabilize hemodynamics and reduce the need for opioids during surgery [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Ghojazadeh et al. (2022) conducted a systematic review on the use of Dex for procedural sedation in emergency departments [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. This review emphasized its efficacy in providing sedation with a favorable safety profile compared to traditional sedatives. The analysis pointed out that Dex could lead to lower rates of respiratory depression and shorter recovery times, making it a valuable option for emergency settings [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Mahmoodpoor et al. (2020) discussed the use of Dex as an all-in-one sedation drug for critically ill patients with COVID-19 [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. The study underscored its utility in managing sedation while minimizing opioid use, which is particularly important given the respiratory complications associated with COVID-19 [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. The findings suggest that Dex may help improve patient outcomes by providing effective sedation without exacerbating respiratory issues.\u003c/p\u003e\u003cp\u003eA significant knowledge gap exists in the use of dexmedetomidine for upper endoscopy sedation, particularly regarding its long-term safety, cost-effectiveness, and standardization of dosages across diverse patient populations. While studies have shown dexmedetomidine to be as effective and safe as midazolam and propofol, with benefits such as reduced gagging and hypoxia risk, there is a need for more comprehensive comparative studies with other sedatives like ketamine combinations [\u003cspan additionalcitationids=\"CR47\" citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Additionally, research on the impact of cultural and socioeconomic factors on patient preferences and outcomes related to dexmedetomidine sedation is lacking. In regions like Palestine, local clinical trials and studies on accessibility and training for healthcare providers are essential to tailor sedation practices to local needs and infrastructure. Addressing these gaps could enhance the safe and effective use of dexmedetomidine in upper endoscopy worldwide. There has been minimal research on the use of Dexmedetomidine in endoscopy, both globally and within Palestine, despite its proven usefulness, efficacy, and safety across various medical applications [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. The aim of this study is to compare the efficacy and safety of Midazolam and Dexmedetomidine for sedation during upper endoscopy, focusing on respiratory and hemodynamic stability, sedation quality, recovery time, and patient and endoscopist satisfaction. Primary outcomes include changes in vital signs, sedation level, time to sedation, recovery time, and need for additional doses. Secondary outcomes assess patient and endoscopist satisfaction, including anxiety, discomfort, gagging, and technical difficulty. The study aims to identify a safer, more effective sedative with minimal adverse effects.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study follows a prospective, observational design aimed at comparing two sedation interventions for patients undergoing elective upper endoscopy. Two groups of patients were observed: one group received the sedative Dexmedetomidine, while the other was administered Midazolam. Both groups underwent a pre-test assessment to establish baseline data before the intervention. Post-intervention, outcomes were measured using a post-test assessment to evaluate the efficacy and safety of each sedative in achieving the desired sedation level, maintaining patient comfort, and minimizing complications. The same endoscopist performed all procedures to maintain consistency in technique, while the anesthesiologist, who was not involved in the research data analysis, conducted the sedation to reduce bias.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Setting and Site\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in the Endoscopic Department at An-Najah National University Hospital, located in Nablus, Palestine. The department serves a range of patients undergoing diagnostic and therapeutic endoscopic procedures. All procedures followed standard protocols established by the hospital\u0026rsquo;s endoscopy team and took place in a clinical environment with access to emergency equipment, ensuring patient safety throughout the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study population consisted of adult outpatients scheduled for elective upper endoscopy procedures at An-Najah National University Hospital. An-Najah National University Hospital is a general hospital in Nablus, Palestine, established in 2013. It\u0026apos;s a non-profit teaching hospital affiliated with An-Najah National University. The hospital started with 127 beds, with plans to expand to nearly 500 but now with 135 bed. It has various departments like Surgery, Internal Medicine, Pediatrics, Anesthesia, and Radiology. It\u0026apos;s a private institution and a referral center, serving patients from the West Bank and Gaza Strip.Inclusion criteria focused on patients aged 18 to 60 with American Society of Anesthesiologists (ASA) physical status classifications of I or II, indicating patients with no or mild systemic disease. Data collection took place from October 2021 to January 2022. The study received ethical approval from the Institutional Review Board (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. Written informed consent was obtained from each participant, and confidentiality, autonomy, and the right to withdraw were assured throughout the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion and Exclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInclusion criteria included patients aged 18\u0026ndash;60 with ASA physical status I or II. Exclusion This study included patients aged 18 to 60 years who were classified as ASA (American Society of Anesthesiologists) physical status I or II and scheduled for elective upper gastrointestinal endoscopy. Patients with severe systemic diseases, classified as ASA III or higher, were excluded. Additionally, individuals with known allergies to Dexmedetomidine, Midazolam, or any of the medications used in the study protocol were not eligible to participate. Pregnant or lactating women, patients with psychiatric disorders, or those unable to provide informed consent were also excluded. The study further excluded individuals currently taking medications known to interact with the study drugs, such as central nervous system depressants, and those with a history of substance or alcohol abuse. Finally, any patients with contraindications to sedation or endoscopic procedures were excluded from participation. A total of 68 patients met the inclusion criteria and were enrolled in the study, with no exclusions following the initial screening process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling and Sample Size Calculation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA sample size calculation was performed based on an expected difference in satisfaction and sedation efficacy between the two drugs, using a type I error (\u0026alpha;) of 0.05 and a type II error (\u0026beta;) of 0.20 to ensure an 80% power to detect statistical significance. Based on prior studies, it was anticipated that patients receiving Dexmedetomidine would report a higher satisfaction rate (90%) compared to those receiving Midazolam (55%). Using an online sample size calculator for two-proportion testing, it was determined that each group required 34 participants, totaling 68 patients, after accounting for a potential 10% dropout rate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRandomization\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients were randomly assigned to either the dexmedetomidine or midazolam group using a computer-generated randomization sequence. To reduce selection bias, the sequence was generated independently by a researcher not involved in the clinical procedures or data analysis. Although the study was not blinded, all data collection and analysis were performed objectively using predefined criteria\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection Tools and Procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData was systematically gathered using three structured tools to ensure a comprehensive and reliable approach (Appendix A). First, a Sociodemographic Data Sheet was used to document each patient\u0026rsquo;s initials, case number, age, gender, height, weight, BMI, substance use history, education level, and the reason for undergoing endoscopy (such as dysphagia, esophageal reflux, or dyspepsia). This information provided essential background on each participant, supporting the analysis of how these factors might influence sedation and recovery.\u003c/p\u003e\n\u003cp\u003eIn addition, a Sedation and Recovery Times record was maintained for each patient, capturing the time needed to achieve full sedation (defined as a Ramsay Sedation Scale [RSS] score of \u0026le;4), the time to reach recovery (RSS score of 2), and the overall duration of the endoscopic procedure. Post-procedure recovery was tracked at specified intervals of 15, 30, and 45 minutes to ensure a thorough assessment of each sedative\u0026rsquo;s effectiveness and safety.\u003c/p\u003e\n\u003cp\u003eFinally, a Follow-up Observation Sheet was designed to monitor sedation depth and the physiological responses of each patient at key time points throughout the procedure. Observations were recorded before sedation (baseline), immediately before endoscopy initiation (aiming for RSS 3-4), five minutes into the endoscopy or upon any significant changes, and one hour post-endoscopy to identify any delayed adverse effects. This sheet documented vital signs and side effects such as bradycardia, tachycardia, hypotension, hypertension, respiratory issues, and any signs of patient discomfort, allowing a continuous assessment of patient safety.\u003c/p\u003e\n\u003cp\u003eThe datasheet\u0026rsquo;s validity was ensured through a review process involving a panel of experts that included two anesthesiologists, an academic with specialization in nurse anesthesia, an anesthesia nurse, and a statistician. Their input helped ensure the tool\u0026rsquo;s alignment with both clinical and research standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection Process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data collection process spanned three main phases: pre-procedure, during the procedure, and post-procedure (Fig. 1).\u003c/p\u003e\n\u003cp\u003ePre-Procedure: Each patient was briefed on the study objectives and procedure, after which they signed a consent form. Baseline data, including vital signs and American Society of Anesthesiologists (ASA) classification, were recorded to establish a starting point for comparison. To ensure safety, an emergency resuscitation cart was prepared. Each patient was also advised to have a responsible adult accompany them home, as the effects of sedation could temporarily impair alertness.\u003c/p\u003e\n\u003cp\u003eDuring the Procedure: Patients were positioned in the left lateral position, with continuous monitoring of blood pressure, pulse oximetry, and heart rate throughout the procedure. Sedation was administered according to the group assignment: In the Dexmedetomidine group, each patient received 0.3 mcg/kg of Dexmedetomidine combined with 1 mcg/kg of Fentanyl intravenously, ten minutes before the procedure, followed by a continuous Dexmedetomidine infusion. In the Midazolam group, each patient received 0.05 mg/kg of Midazolam and 1 mcg/kg of Fentanyl intravenously, with additional doses of Midazolam administered every 2\u0026ndash;5 minutes as needed to achieve the desired sedation level. The Ramsay Sedation Scale (RSS) was used to assess sedation depth during the procedure, aiming for an RSS score 4 or more.\u003c/p\u003e\n\u003cp\u003ePost-Procedure: Following the endoscopy, patients were closely monitored until they achieved a full recovery, indicated by an RSS score of 2. Discharge readiness was assessed using the Post-Anesthesia Recovery Scoring System (PARS). Patients were informed of possible post-procedure effects, such as mild throat soreness, and advised to avoid activities requiring full alertness until they were fully recovered.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatient and endoscopy specialist satisfaction were assessed using a structured 1 to 10 scale, ranging from \u0026quot;very dissatisfied\u0026quot; to \u0026quot;very satisfied.\u0026quot; Patient satisfaction evaluation covered aspects such as anxiety, gagging, discomfort, and overall satisfaction, while endoscopy specialist satisfaction included technical difficulty, satisfaction with the patient\u0026rsquo;s sedation level, and observations of patient discomfort, retching, and gagging.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted with IRB approval from An-Najah National University and in compliance with the Declaration of Helsinki. All participants received information about the study\u0026rsquo;s objectives, methods, and potential risks. Written consent was obtained, and participants retained the right to withdraw at any stage. Patient confidentiality was protected, and all data was securely stored and anonymized during analysis. Participants were informed that sedation was used for their comfort and that an experienced endoscopist and anesthesiologist would monitor the procedure to ensure safety.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analysis was performed using SPSS software version 20. Continuous variables were summarized as means and standard deviations, while categorical data were presented as counts and percentages. Statistical tests, such as the t-test for continuous variables and chi-square for categorical variables, were conducted to assess differences between the two groups. Statistical significance was set at p \u0026lt; 0.05.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThis study aimed to compare the Midazolam and Dexmedetomidine used for upper endoscopy performed under sedation, The primary outcome: vital signs changes, including mean arterial pressure, oxygen saturation , respiration rate, and heart rate of the patients and Ramsay sedation scale (RSS), time to full sedation, time to full recovery, an additive dose of any sedative or analgesic drug and if using of any drug to treat any side effect during the procedure. Secondary outcomes included: patient and endoscopy specialist satisfaction and adverse effects, regarding patient: anxiety, gagging, discomfort, and satisfaction, regarding endoscopy specialist: technical difficulty, satisfaction with the patient\u0026rsquo;s sedation level, patient discomfort, patient retching, and patient gagging.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDemographic Data of patients in Midazolam and Dexmedetomidine group\u003c/strong\u003es\u003c/p\u003e\n\u003cp\u003eThe study recruited 68 patients, who were randomly assigned to receive either Midazolam or Dexmedetomidine (n=34/group). Demographic and clinical data of the patients are shown in Table 1. There were no statistically significant differences between groups in sex distribution, age, BMI, smoking distribution and education level. While there was a significant difference in endoscopy duration between the two groups, Dexmedetomidine required 11.0 \u0026plusmn; 1.9 minutes and Midazolam required 9.9 \u0026plusmn; 1.5 minutes, p=0.008.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"603\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 603px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003eDemographic Data of patients in Midazolam group and Dexmedetomidine group. Data is reported as Mean Standard deviation (SD) unless otherwise stated.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 187px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMidazolam group (n=34)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDexmedetomidine group (n=34)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 187px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, year*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e39.8 \u0026plusmn; 13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e40.8 \u0026plusmn; 11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.744\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 187px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex, Male%/Female%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e47.05%/52.95%\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e52.95% /47.05%/\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.809\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 187px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBody mass index, kg/m2*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e28.1 \u0026plusmn; 6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e28.4 \u0026plusmn; 4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.429\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 187px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of endoscopy, min*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e9.9 \u0026plusmn; 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e11.0 \u0026plusmn; 1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 187px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e35.29%\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e20.58%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.280\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 187px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation level, n\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 187px;\"\u003e\n \u003cp\u003egrammar school%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e2.94%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.543\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 187px;\"\u003e\n \u003cp\u003ehigh school%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e29.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e20.59%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.475\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 187px;\"\u003e\n \u003cp\u003eCollege%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e38.23%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e35.29%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.841\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 187px;\"\u003e\n \u003cp\u003egraduate school%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e29.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e41.17%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.542\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 187px;\"\u003e\n \u003cp\u003e*Mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eIndications for endoscopy in Midazolam and Dexmedetomidine groups\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhen it came to endoscopic indications, there was a significant difference between the groups. When it came to dysphagia: 12/34 (35.3%) patients in the Midazolam group and 17/34 (50%) patients in the Dexmedetomidine group, p=0.032. There were also significant differences between the groups in terms of esophageal reflux, with 17/34 (50%) patients in the Midazolam group and 7/34 (20.5) patients in the Dexmedetomidine group, respectively, p=0.035. As well as significant differences in Dyspepsia across the groups 5/34 (14.7%) patients in the Midazolam group and 10/34 (29.4%) patients in the Dexmedetomidine group, p=0.031.(Table 2).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"593\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 593px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2\u0026nbsp;\u003c/strong\u003eIndications for endoscopy in Midazolam and Dexmedetomidine groups\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMidazolam group \u0026nbsp; (n=34)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDexmedetomidine group \u0026nbsp;(n=34)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDysphagia%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e35.29%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.032\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEsophageal reflux symptoms%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e20.59%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.035\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDyspepsia%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e14.70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e29.41%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.031\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 593px;\"\u003e\n \u003cp\u003eData presented as n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePre-procedural expected patient satisfaction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExpected patient satisfaction before receiving Midazolam or Dexmedetomidine is not significantly different between the two groups for Satisfaction and discomfort (p \u0026gt;.05), but there is a significant difference between groups for gagging and anxiety. Mean gagging for Midazolam is lower than Dexmedetomidine 1.0\u0026plusmn; 1.1versus 1.6 \u0026plusmn;1.1, p=0.020), and mean anxiety for Midazolam is higher than Dexmedetomidine, 2.6 \u0026plusmn; 0.9 versus 2.1 \u0026plusmn; 1.4, p=0.018 (Table 3).\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"593\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 593px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3\u0026nbsp;\u003c/strong\u003ePre-procedural expected patient satisfaction, discomfort, gagging and anxiety score. \u0026nbsp;Data presents as mean (\u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMidazolam group \u0026nbsp; (n=34)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDexmedetomidine group (n=34)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExpected Satisfaction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e7.7 \u0026plusmn; 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e7.1 \u0026plusmn; 1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.228\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExpected Discomfort\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1.7 \u0026plusmn; 1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e2.1 \u0026plusmn; 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.515\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExpected gagging\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1.0 \u0026plusmn; 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e1.6 \u0026plusmn; 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e2.6 \u0026plusmn; 0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e2.1 \u0026plusmn; 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.018\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003ePost-procedural patient satisfaction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 4 shows the patient satisfaction after receiving Midazolam or Dexmedetomidine. Except for the gagging score, there are significant variations between the two groups in terms of satisfaction, discomfort, and anxiety (Table 4). There was a significant difference in satisfaction between the Dexmedetomidine group (9.1 \u0026plusmn; 1.0) and the Midazolam group (8.06 \u0026plusmn; 0.9), p=0.001. There was a significant difference in discomfort between the Dexmedetomidine group (0.7 \u0026plusmn; 0.9) and the Midazolam group (1.7 \u0026plusmn; 1.1), p=0.001. There was a substantial difference in anxiety between the Dexmedetomidine group 0.5 \u0026plusmn; \u0026nbsp; 0.8 and the Midazolam group 1.8 \u0026nbsp;\u0026plusmn; 1.4, p=0.001. When compared to the Midazolam group, the Dexmedetomidine group demonstrated much higher satisfaction, less discomfort, and less anxiety (Fig. 2).\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"584\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 584px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 4\u0026nbsp;\u003c/strong\u003ePost-procedural patient satisfaction, discomfort, gagging and anxiety score. \u0026nbsp;Data presents as mean (\u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMidazolam group \u0026nbsp;(n=34)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDexmedetomidine group \u0026nbsp; \u0026nbsp; (n=34)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 177px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSatisfaction (0-10 score)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e8.06 \u0026plusmn; 0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e9.1 \u0026plusmn; 1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 177px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiscomfort (0-10 score)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e1.7 \u0026plusmn; 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.7 \u0026plusmn; 0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 177px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGagging (0-10 score)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.7 \u0026plusmn; 0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.6 \u0026plusmn; 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 177px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety (0-10 score)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e1.8 \u0026plusmn; 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.5 \u0026plusmn; 0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eEndoscopy specialist\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;satisfaction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients receiving Dexmedetomidine had significantly better endoscopic specialist satisfaction than those receiving Midazolam (8.7\u0026plusmn;1.6 versus 8.2\u0026plusmn;1.0); P=0.001. Respectively. Patients taking Dexmedetomidine had significantly less discomfort than those receiving Midazolam (1.0 \u0026plusmn; 1.4versus 1.8 \u0026plusmn; 0.9); p=0.037. Patients taking Dexmedetomidine had considerably less gagging than those receiving Midazolam (0.8 \u0026plusmn; 1.3versus 1.0 \u0026plusmn; 0.8; p=0.036).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlso Patients taking Dexmedetomidine had considerably less retching than those receiving Midazolam (0.5\u0026plusmn;1.1 versus 0.6\u0026plusmn;0.6; P0.013) (Table 5). There was a significant difference in technical difficulty between the Dexmedetomidine and Midazolam groups, with the Dexmedetomidine group scoring 1.1 \u0026plusmn; 1.1vs the Midazolam group scoring 1.6 \u0026plusmn; 0.8, p=0.035. In all facets of endoscopic specialist, the Dexmedetomidine group outperformed the Midazolam group (Fig. 3).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"584\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 584px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 5\u0026nbsp;\u003c/strong\u003eEndoscopy specialist satisfaction, discomfort, gagging, retching, and technical difficulty. Data reported as Mean (\u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMidazolam group \u0026nbsp; (n=34)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDexmedetomidine group \u0026nbsp; \u0026nbsp; (n=34)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSatisfaction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e8.2 \u0026plusmn; 1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e8.7 \u0026plusmn; 1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiscomfort\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e1.8 \u0026plusmn; 0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e1.0 \u0026plusmn; 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003egagging\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e1.0 \u0026plusmn; 0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.8 \u0026plusmn; 1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRetching\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e0.6 \u0026plusmn; 0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.5 \u0026plusmn; 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTechnical difficulty\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e1.6 \u0026plusmn; 0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e1.1 \u0026plusmn; 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eRecovery data in Midazolam and Dexmedetomidine groups\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn table 6 for average recovery, Dexmedetomidine patients were recovered faster than Midazolam patients (Fig. 4), Midazolam patients need 48.8 \u0026plusmn; 6.0 min to recover while the Dexmedetomidine patients need 18.0 \u0026plusmn; 5.2 min and this difference significant since the p \u0026lt;.05, Midazolam need 2.4 \u0026plusmn; 7.7 min to sedate while the Dexmedetomidine need 9.5 \u0026plusmn; 1.1 min and this difference significant since the p \u0026lt;.05 (Fig. 5).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"bottom\" style=\"width: 595px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 6\u0026nbsp;\u003c/strong\u003eRecovery data in Midazolam and Dexmedetomidine groups.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMidazolam group \u0026nbsp; (n=34)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDexmedetomidine group \u0026nbsp; \u0026nbsp; (n=34)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime min RSS 4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e2.4 \u0026plusmn; 7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e9.5 \u0026plusmn; 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime min RSS =2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e48.8 \u0026plusmn; 6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e18.0 \u0026plusmn; 5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"bottom\" style=\"width: 595px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients fully recovered, n (%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 130px;\"\u003e\n \u003cp\u003e15 Min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 198px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 189px;\"\u003e\n \u003cp\u003e17 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 130px;\"\u003e\n \u003cp\u003e30 Min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 198px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 189px;\"\u003e\n \u003cp\u003e17 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 130px;\"\u003e\n \u003cp\u003e45 Min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 198px;\"\u003e\n \u003cp\u003e34 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 189px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"bottom\" style=\"width: 595px;\"\u003e\n \u003cp\u003eData presented as Mean (\u0026plusmn;SD) and as n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAdverse effect\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRegarding side effect, Table 7 represent the most side effect after receiving Midazolam or Dexmedetomidine, While assessing the following side effects, which are: hypertension, hypotension, tachycardia, bradycardia, hypoxia, tachypnea, bradypnea, apnea, coughing, vomiting, retching, nausea, allergies, and abnormal body movements. The most frequent side effect was hypertension for both groups. It was found that the occurrence of side effects in the Dexmedetomidine group was less than in the Midazolam group but it was not significant.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"647\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 647px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 7\u0026nbsp;\u003c/strong\u003eAdverse effects in Midazolam and Dexmedetomidine groups\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 246px;\"\u003e\n \u003cp\u003eMidazolam group\u0026nbsp;\u003cbr\u003e\u0026nbsp; \u0026nbsp;(n=34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003eDexmedetomidine group\u0026nbsp;\u003cbr\u003e\u0026nbsp; \u0026nbsp;(n=34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eBradycardia%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 246px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e8.82%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.076\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eHypertension%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 246px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e17.64%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e17.64%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.493\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eCoughing%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 246px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e8.82%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e2.94%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.303\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eTachycardia%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 246px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e5.88%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.151\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eNausea%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 246px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e2.94%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.314\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eHypotention%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 246px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eVital signs of the patients in both Midazolam and Dexmedetomidine groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRegarding vital signs, there is no significant difference between the Midazolam group and the Dexmedetomidine group, except for respiratory rate, Dexmedetomidine group has less rate compared to the Midazolam group 16.7 \u0026plusmn; 1.9, 18.6 \u0026plusmn; 4.7 respectively, p=0.028. Tables 8 to 12 provide an overview of the vital signs measured at four time points for patients in the Midazolam and Dexmedetomidine groups. Table 8 presents the overall vital signs, including Mean Arterial Pressure (MAP), Heart Rate (HR), Oxygen Saturation (SpO2), and Respiratory Rate (RR). The results showed no significant differences between the two groups for MAP, HR, and SpO2 at any of the time points. However, a significant difference was found in Respiratory Rate, where the Dexmedetomidine group consistently had lower rates compared to the Midazolam group\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"649\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 649px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTabe 8\u003c/strong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eVital signs of the patients in both Midazolam and Dexmedetomidine groups\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eMidazolam group \u0026nbsp; (n=34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eDexmedetomidine group \u0026nbsp; \u0026nbsp; (n=34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eMean Arterial Pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e90.7 \u0026plusmn; 6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e91.4 \u0026plusmn; 8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.713\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eHeart Rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e80.7 \u0026plusmn; 11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e77.4 \u0026plusmn; 11.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.238\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eoxygen saturation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e97.7 \u0026plusmn; 1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e97.8 \u0026plusmn; 2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.861\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp;Respiratory Rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e18.6 \u0026plusmn; 4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e16.7 \u0026plusmn; 1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.028\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 649px;\"\u003e\n \u003cp\u003e\u003cem\u003eData displayed as Mean (\u0026plusmn; SD)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 9 focuses specifically on MAP at the four points, showing no significant differences between the groups at any of the time points (p \u0026gt; 0.05).\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"649\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 99.8459%;\" colspan=\"6\"\u003e\n \u003cp\u003e\u0026nbsp;\u003cstrong\u003eTabe 9\u0026nbsp;\u003c/strong\u003eMAP in both Midazolam and Dexmedetomidine groups\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eMidazolam group \u0026nbsp; (n=34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003eDexmedetomidine group \u0026nbsp; \u0026nbsp; (n=34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003ePoint 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e92.7 \u0026plusmn; 11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e92.7 \u0026plusmn; 10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e0.896\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003ePoint 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e91.3 \u0026plusmn; 7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e95.9 \u0026plusmn; 13.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e0.311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003ePoint 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e89.7 \u0026plusmn; 10.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e90.2 \u0026plusmn; 8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e0.777\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003ePoint 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e88.7 \u0026plusmn; 9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e88.4 \u0026plusmn; 11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e0.658\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"bottom\" style=\"width: 649px;\"\u003e\n \u003cp\u003e\u003cem\u003eData displayed as Mean (\u0026plusmn; SD)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 10 displays the Heart Rate (HR) at each point, with no significant differences at points 1, 2, and 4. However, at point 3, there was a significant difference (p = 0.049), with the Dexmedetomidine group showing a lower HR compared to the Midazolam group\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"686\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 99.8542%;\" colspan=\"6\"\u003e\n \u003cp\u003e\u0026nbsp;\u003cstrong\u003eTabe 10\u0026nbsp;\u003c/strong\u003eHR in both Midazolam and Dexmedetomidine groups\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 234px;\"\u003e\n \u003cp\u003eMidazolam group (n=34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eDexmedetomidine group \u0026nbsp; \u0026nbsp; (n=34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003ePoint 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 234px;\"\u003e\n \u003cp\u003e80.91 \u0026plusmn; 16.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003e80.18 \u0026plusmn; 13.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.654\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003ePoint 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 234px;\"\u003e\n \u003cp\u003e81.03 \u0026plusmn; 13.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003e77.977\u0026plusmn; 15.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.353\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003ePoint 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 234px;\"\u003e\n \u003cp\u003e80.82 \u0026plusmn; 14.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003e75.74\u0026plusmn; 13.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003ePoint 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 234px;\"\u003e\n \u003cp\u003e78.8 \u0026plusmn; 12.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003e74.79 \u0026plusmn; 11.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.163\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"bottom\" style=\"width: 649px;\"\u003e\n \u003cp\u003e\u003cem\u003eData displayed as Mean (\u0026plusmn; SD)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 11 presents SpO2 measurements, where no significant differences were observed at any time point (p \u0026gt; 0.05).\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"627\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 627px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTabe 11\u0026nbsp;\u003c/strong\u003eSpO2 in both Midazolam and Dexmedetomidine groups\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003eMidazolam group \u0026nbsp;(n=34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003eDexmedetomidine group (n=34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003ePoint 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e97.65 \u0026plusmn; 1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e98.65 \u0026plusmn; 2.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003ePoint 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e97.59 \u0026plusmn; 1.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e97.50 \u0026plusmn; 2.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e0.970\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003ePoint 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e97.24 \u0026plusmn; 1.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e97.09 \u0026plusmn; 2.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e0.975\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003ePoint 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e97.29 \u0026plusmn; 1.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e96.97 \u0026plusmn; 3.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e0.797\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFinally, Table 12 highlights Respiratory Rate (RR) at the four points. Significant differences were observed at points 3 and 4, with the Dexmedetomidine group showing significantly lower RR at both time points (p = 0.004 at point 3 and p = 0.001 at point 4) compared to the Midazolam group.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"691\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"bottom\" style=\"width: 579px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTabe 12\u0026nbsp;\u003c/strong\u003eRR in both Midazolam and Dexmedetomidine groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003eMidazolam group \u0026nbsp; (n=34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003eDexmedetomidine group (n=34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 53px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003ePoint 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e17.74 \u0026plusmn; 0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e16.53 \u0026plusmn; 2.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003ePoint 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e17.59 \u0026plusmn; 0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e17.00 \u0026plusmn; 2.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.970\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003ePoint 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e17.38 \u0026plusmn; 0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e15.82 \u0026plusmn; 2.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003ePoint 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e20.38 \u0026plusmn; 0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e16.06 \u0026plusmn; 2.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"bottom\" style=\"width: 649px;\"\u003e\n \u003cp\u003e\u003cem\u003eData displayed as Mean (\u0026plusmn; SD)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe result of the current study proved the efficacy and safety of using Dexmedetomidine and its superiority to Midazolam in many aspects, such as patient satisfaction, endoscopy specialists\u0026rsquo; satisfaction, stability of vital signs, and the lack of side effects, as well as the speed of recovery after procedure, which reduces the patient\u0026rsquo;s stay in the hospital and increases the occupancy rate of the department to provide places for patients in a way faster. The importance of this research stems from the large number of side effects expected from the drug Midazolam, these findings are consistent with those of other research that have been published which were shown that the concomitant use of Midazolam with analgesia drugs increases the risk of respiratory and circulatory failure in patients [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e] Bartolom\u0026eacute; et al., 2007) [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e], its toxicity, its conflict with many drugs, and the many caveats with many pathological conditions [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] Add to that the length of the patient's stay in recovery departments, which reduces the possibility of receiving other cases [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. As a result, there was a need to look for a safe and effective alternative to meet the endoscopic anesthetic need.\u003c/p\u003e \u003cp\u003eDuring this research, Midazolam and Dexmedetomidine were compared in upper endoscopy only, and the drug Fentanyl was used as analgesia, as many researches [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. But in other research, Remifentanil was used as an analgesia [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], another used topical lidocaine [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], Others, on the other hand, did not utilize analgesics and instead focused on treating pain with the effects that each of the two medications has on patients [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe ratio of males to females in this study was randomly 1:1, While in other studies, the percentage of males was more than female, percentage was as follows 62% [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], 55% [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] and 52% [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. On the contrary, the percentage of males was lower in other studies, and their percentage was as follows 44% [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], 46% [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and 45% [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere are significant difference between two groups for all binoculars of patient satisfactions except gagging score, Dexmedetomidine group showed higher satisfaction, less discomfort and less anxiety compared to Midazolam group.In Demiraran and his colleges research, both gropes showed satisfactory and similar results in terms of anxiety, discomfort and gagging, as well as patient satisfaction [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In another study for the gagging assessment, more occurrence were observed in the Midazolam group than in the Dexmedetomidine group [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. And in a systematic review study for 12articles including 883 patients, the superiority and merit of Dexmedetomidine over Midazolam was shown in patient satisfaction [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Also in a meta-analysis for 9 eligible randomized controlled trials included 657 patients, the superiority of Dexmedetomidine was shown in patient satisfaction aspect over Midazolam [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In a retrospective randomized study for 60 adult patients, the satisfaction in the Dexmedetomidine group was higher, [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The results in terms of patient satisfaction were preferable to the Dexmedetomidine group in a Prospective, randomized, single-blinded preliminary trial including 198 patients [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].Finally, the satisfaction of patients was the highest in the Dexmedetomidine group in a randomized controlled trial for 60 patients [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe endoscopy specialist rating for all satisfaction aspects was significant difference between two groups, for patient satisfaction significantly higher in the patients receiving Dexmedetomidine than those receiving Midazolam (87.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 versus 8.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0; P\u0026thinsp;=\u0026thinsp;0.001). Retching was significantly lower in patients receiving Dexmedetomidine compared with those receiving Midazolam (0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 versus 0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Dexmedetomidine group showed better than Midazolam group in all Visual analog scale (VAS) score. This was in line with many studies that support the superiority of Dexmedetmomidine over Midazolam in the context of specialist satisfaction, and this was demonstrated by Barends and colleagues in the Systemic Review Study, which was conducted in 2017 [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. In another study, the endoscopy was performed by the same specialist, and the scale was weighed in favor of Dexmedetomidine in the context of the specialists\u0026rsquo; satisfaction, where several criteria were considered, which are the patient's discomfort from the specialist's point of view, satisfaction with the patient's sedation, technical problems, gagging and retching [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In another study, to examine the specialists\u0026rsquo; satisfaction with using criteria from one to four, where one is poor, followed by Fair, then Good, and then Excellent, the superiority of Dexmedetemomidine over the other drug was shown through this scope [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. In another study, a tool with two options, either satisfied or very satisfied, was used to assess the specialist\u0026rsquo;s satisfaction, and the results showed similar results to the previous one with the superiority of Dexmedetomidine [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. In the research conducted by Zhiqiang Lu and his colleagues in a study that included 198 patients, it was found that the specialist\u0026rsquo;s satisfaction in the Dexmedetomidine group is not different from his satisfaction in the Midazolam group. A scale of one to six was used to assess their satisfaction, with six being very satisfactory [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor average recovery, Dexmedetomidine patients were recovered faster than Midazolam patients, 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. One of the studies that used a mechanism to assess the time required to recover from sedation, as the time was calculated from the moment the procedure ended until reaching modified ramsay sedation score 2, it showed that the duration of recovery in the Dexmedetomidine group is shorter than in the Midzolam group, but the difference does not constitute a statistical difference [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Further research showed that ninety percent of the Dexmedetomidine group achieved a Modified Aldrete score of nine or more within five minutes of completing the procedure, while seventeen percent of the Midazolam group showed the same result after the same period and the difference was statistically different [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding to vital signs, there are no significant difference between Midazolam group and Dexmedetomidine group, except respiratory rate, Dexmedetomidine group has less rate compared to Midazolam group 16.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9, 18.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7 respectively. In a review of a group of studies examining the safety of Dexmedetomidine on the respiratory system compared to Midazolam, it was found that twenty cases of hypoxemia occurred in the Dexmedetomidine group compared to twenty-four cases. So that this research included an analysis of evidence for seven hundred and sixty-seven cases, and this difference was not statistically significant, while both showed safety in terms of affecting the circulatory system in the same research, so that during the analysis of the data, the striking results were those that were mentioned in eight studies, where there was a drop in blood pressure for ten patients in the Dexmedetomidine group compared to seven patients in the Midazolam group and this difference is not statistically different, and two of the studies that were analyzed showed the emergence of some cases of high blood pressure in the Midazolam group(Barends et al., 2017).In analyzing the results of five studies with no significant heterogeneity in data, it was found that there is no difference between the two drugs in the effect on the concentration of oxygen in the blood, the results of six studies with no significant heterogeneity in datashowed that there was no difference in the effect between the two drugs on the mean arterial pressure [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In the research conducted by Wei Wu and his colleagues the preference for the Dexmedetomidine group in terms of the mean arterial pressure reading was lower in the Midazolam group, the blood oxygen concentration was more high in the Dexmedetomidine group [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. In another studythe results showed the following that blood oxygen saturation, mean arterial pressure, heart rate and respiratory rate were similar in the two groups [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. While the Midazolam group showed a higher incidence of decreased blood oxygen concentration than the other group [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The results in terms of safety, there were low incidence of cases of low blood oxygen concentration in the Dexmedetomidine group, and also in the Dexmedetomidine group the median of the Midazolam dose used was lower; In addition to this, the systolic blood pressure reading and heart rate decreased in the Dexmedetomidine group, but no complications that led to heart failure or irregular heartbeats [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Further research showed that in the Dexmedetomidine group, there was a decrease in heart rate, while there was no significant difference in the reading of blood pressure and respiratory rate [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. In the research conducted by Kilic and his colleagues the results showed a lower heart rate in the Dexmedetomidine group, in terms of respiratory rate and MAP the results were similar [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile assessing the following side effects, which are: hypertension, hypotension, tachycardia, bradycardia, hypoxia, tachypnea, bradypnea, apnea, coughing, vomiting, retching, nausea, allergies and abnormal body movements. The most important and most frequent side effect was hypertension for both groups.Eighteen times side effects occurred in the Midazolam group, and they were in the following numbers in each symptom: three in bradycardia, six in hypertension, three in coughing, three in hypoxia, two in tachycardia, one in nausea. Compared to the Dexmedetomidine group, in which five times side effects occurred, four of which were in hypertension and one in coughing. It was found that the occurrence of side effects in the Dexmedetomidine group was less than in the Midazolamgroup.In another study, as for the side effects, only four studies dealt with this matter, and they looked at the following side effects, which are: nausea and vomiting, respiratory depression, dysphoria, dizziness, reflux, pain and abdominal distention, It was found that the occurrence of side effects in the Dexmedetomidine group was less than in the Midazolam group [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. But in another study the results showed that there are no clinically significant complications in the two groups, and that the use of Dexmedetomidine is safe and effective in upper endoscopy [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. While the preferential results of Dexmedetomidine were shown in several aspects, namely, fewer side effects compared to Midazolam, less retching, and a significant increase in specialist satisfaction [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In another study Dexmedetomidine showed less nausea reaction than in the Midazolam group during endoscopy [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Inatomi and his colleagues conclude that, it is no complications that led to heart failure or irregular heartbeats [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In gaging assessment Sethi conclude that the appearance of the gag ​​reaction was more in the Midazolam group than in the Dexmedetomidine group [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Finally Killic and his colleagues conclude that regarding to side effects, nausea, vomiting, and coughing were observed in the Midazolam group, with none in the Dexmedetomidine group [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study provides evidence that Dexmedetomidine offers superior patient and provider satisfaction with faster recovery and fewer side effects compared to Midazolam. These findings support its consideration as a safer and more effective sedative for upper endoscopy, potentially changing clinical practices and enhancing patient outcomes\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eDexmedetomidine demonstrated superior performance over Midazolam for sedation during upper endoscopy, offering significantly faster recovery times, higher patient satisfaction, and greater satisfaction from endoscopists. Additionally, it reduced discomfort, anxiety, and retching, with fewer side effects and no significant difference in vital signs compared to Midazolam. Given these advantages, Dexmedetomidine is a promising alternative sedative for upper endoscopy.\u003c/p\u003e \u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e \u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Limitations","content":"\u003cp\u003eThis study has several limitations that should be considered when interpreting the results. First, it was conducted at a single-center, which may limit the generalizability of the findings to other settings and populations. Second, the relatively small sample size of 68 patients might reduce the statistical power and robustness of the results. Third, the study did not include long-term follow-up to evaluate the sustained effects of Dexmedetomidine and Midazolam, such as their impact on patient outcomes beyond the immediate recovery period. Additionally, the lack of blinding for patients and providers may have introduced potential bias in subjective outcomes, such as satisfaction ratings. Future research should address these limitations by including multicenter designs, larger sample sizes, and longer follow-up periods to validate and expand upon these findings, the exclusion of propofol in our study limits its generalizability and comparison with the most popular sedation protocols.\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\u003eCYP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eCytochromes P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eERCP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eEndoscopic retrograde cholangiopancreatography\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eGauge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eGABA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eGamma aminobutyric acid\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003ehr\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eHour\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eICP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eintracranial pressure\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eintensive care unit\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eIRB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003einstitutional review board\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eIntravenous\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003ekg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003ekilogram\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eLitter\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eMAP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eMean arterial pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eMAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eModified Aldrete Score\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003emcg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eMicrogramme\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003emin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eMinute\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003ePT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eProthrombin time\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003ePTT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003ePartial thromboplastin time\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 \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eStandard deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eSPO2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eOxygen saturation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eVAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eVisual analog 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\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\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., and A.A. All authors reviewed and approved the final manuscript.\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\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received ethical approval from the Institutional Review Board (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\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.\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.\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWaring JP, Baron TH, Hirota WK, Goldstein JL, Jacobson BC, Leighton JA, Mallery JS, Faigel DO: \u003cstrong\u003eGuidelines for conscious sedation and monitoring during gastrointestinal endoscopy\u003c/strong\u003e. \u003cem\u003eGastrointestinal endoscopy\u0026nbsp;\u003c/em\u003e2003, \u003cstrong\u003e58\u003c/strong\u003e(3):317-322.\u003c/li\u003e\n \u003cli\u003eHuang Z, Chen Y-s, Yang Z-l, Liu J-y: \u003cstrong\u003eDexmedetomidine versus midazolam for the sedation of patients with non-invasive ventilation failure\u003c/strong\u003e. \u003cem\u003eInternal medicine\u0026nbsp;\u003c/em\u003e2012, \u003cstrong\u003e51\u003c/strong\u003e(17):2299-2305.\u003c/li\u003e\n \u003cli\u003eOzel AM, Onc\u0026uuml; 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\u003cstrong\u003eVenous complications after intravenous injection of diazepam, flunitrazepam, thiopentone and etomidate\u003c/strong\u003e. \u003cem\u003eActa anaesthesiologica scandinavica\u0026nbsp;\u003c/em\u003e1980, \u003cstrong\u003e24\u003c/strong\u003e(3):227-230.\u003c/li\u003e\n \u003cli\u003eMcElhatton PR: \u003cstrong\u003eThe effects of benzodiazepine use during pregnancy and lactation\u003c/strong\u003e. \u003cem\u003eReproductive Toxicology\u0026nbsp;\u003c/em\u003e1994, \u003cstrong\u003e8\u003c/strong\u003e(6):461-475.\u003c/li\u003e\n\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, gastrointestinal and patient satisfaction","lastPublishedDoi":"10.21203/rs.3.rs-6261635/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6261635/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Endoscopic procedures are vital for diagnosing and treating various conditions but can cause significant discomfort and pain. Sedation is essential to minimize pain, mobility, gagging, and nausea while maintaining respiratory and cardiovascular stability. This study compares the efficacy and safety of Midazolam and Dexmedetomidine in sedation, focusing on patient and endoscopist satisfaction, recovery time, and adverse effects during upper endoscopy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology:\u003c/strong\u003e A prospective observational study was conducted on 68 patients (ages 18–60) classified as ASA grades I or II. The study took place at An-Najah National University Hospital, Nablus, Palestine, from October 2021 to January 2022. Participants were informed about the study's purpose, protocol, and consent process, and written consent was obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Dexmedetomidine showed significantly higher patient and endoscopist satisfaction, faster recovery times, and less discomfort and anxiety compared to Midazolam (p\u0026lt;0.05). Patients sedated with Dexmedetomidine recovered more quickly, with a mean recovery time of 9.5 ± 1.1 minutes compared to 22.4 ± 7.7 minutes for Midazolam, demonstrating a statistically significant advantage (p\u0026lt;0.05). While Dexmedetomidine had fewer side effects, the difference was not statistically significant. No significant differences in vital signs were observed between the two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Dexmedetomidine outperformed Midazolam in recovery time, patient satisfaction, endoscopist satisfaction, and minimizing discomfort, anxiety, and retching. It presents a safe and effective alternative to Midazolam for sedation during upper endoscopy.\u003c/p\u003e","manuscriptTitle":"The comparison of dexmedetomidine and midazolam used for sedation of patients undergoing upper gastrointestinal endoscopy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-07 05:34:42","doi":"10.21203/rs.3.rs-6261635/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":"May 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":47405498,"name":"Health sciences/Gastroenterology"},{"id":47405499,"name":"Health sciences/Health care"}],"tags":[],"updatedAt":"2025-05-07T05:34:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-07 05:34:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6261635","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6261635","identity":"rs-6261635","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}