Dexmedetomidine-Propofol Versus Propofol Alone for Sedation in Upper Gastrointestinal Endoscopic Ultrasound: A Randomized Comparative Study

Purpose

Upper gastrointestinal endoscopic ultrasonography (EUS) necessitates well-balanced sedation to ensure patient safety while optimizing procedural conditions. This study evaluates the safety and efficacy of dexmedetomidine-propofol versus propofol-only sedation in terms of respiratory safety, sedation quality, and recovery outcomes.

Methods

This prospective randomized controlled trial enrolled 145 patients undergoing lower esophageal or gastric EUS from January 2022 to May 2023. All participants received standardized premedication with midazolam and tetracaine gel for mucosal topicalization. Participants were randomized into two groups: dexmedetomidine-propofol (n = 72) and propofol-only (n = 73). Continuous variables were analyzed using independent t-tests, and categorical data were compared with chi-square tests, with statistical significance set at P < 0.05.

Findings

No significant difference was observed in patient satisfaction (P = 0.717), but endoscopist satisfaction was significantly higher in the dexmedetomidine-propofol group (P < 0.05). This group also showed significantly fewer midazolam rescue doses, fewer respiratory adverse events, and reduced intra-procedural patient movement and cough reflexes (all P < 0.05). Furthermore, recovery outcomes were improved, with higher modified Aldrete scores and faster achievement of a post-anesthesia discharge score ≥9 (P < 0.05). However, induction time was longer and the incidence of hypotension and bradycardia was higher in the combination group (P < 0.05).

Implications

Dexmedetomidine-propofol sedation enhances procedural conditions and recovery metrics in EUS but is associated with greater cardiovascular side effects. These findings suggest it is a valuable alternative to propofol alone, particularly when optimizing proceduralist satisfaction and minimizing respiratory complications.