Background Upper gastrointestinal endoscopy often causes discomfort and anxiety,

requiring effective sedation to ensure patient comfort and procedural safety. This study

compared the efficacy and safety of Midazolam and Fentanyl versus Dexmedetomidine

and Fentanyl sedation during upper endoscopy, it was conducted as a preliminary

investigation to guide the design of a future definitive trial.

Methods A prospective pilot study was conducted at An-Najah National University

Hospital, Palestine, from October 2021 to January 2022. Sixty-eight ASA I and II

outpatients aged 18–60 years were assigned to receive either Dexmedetomidine

(0.3 mcg/kg) or Midazolam (0.05 mg/kg), both with Fentanyl (1 mcg/kg). Sedation

depth was assessed using the Ramsay Sedation Scale (RSS) and recovery by the

Post-Anesthesia Recovery Score (PARS). All procedures were performed by the same

endoscopist; sedation was administered by an independent anesthesiologist.

Results Dexmedetomidine led to significantly higher patient and endoscopist

satisfaction, shorter recovery time (9.5±1.1 vs. 22.4±7.7 min, p<0.05), and reduced

anxiety and discomfort. Adverse effects were fewer but not significantly different. Vital

signs remained stable in both groups.

Conclusion Dexmedetomidine and Fentanyl offers a more effective and better

tolerated sedation option than Midazolam and Fentanyl for upper endoscopy, with

higher satisfaction and faster recovery.

Keywords Conscious sedation, Dexmedetomidine, Endoscopy, Gastrointestinal,

Midazolam, Patient satisfaction, Recovery time