Comparative Study of Fentanyl–Propofol Versus Fentanyl–Dexmedetomidine for Intravenous Anaesthesia During Upper Gastrointestinal Endoscopy

Background: Upper GI endoscopy is increasingly being used for diagnosis of gastrointestinal conditions. It requires intravenous sedation or anesthesia to improve patients' comfort and procedural conditions. Propofol provides rapid onset and recovery but may cause respiratory depression. Dexmedetomidine provides sedation with relative preservation of respiratory functions but is associated with bradycardia and delayed recovery. The current study aimed to compare the efficacy, hemodynamic stability, and recovery characteristics of fentanyl–propofol and fentanyl–dexmedetomidine for intravenous anesthesia during upper gastrointestinal endoscopy. Material and Methods: This prospective comparative observational study was done on n=60 adult patients undergoing upper gastrointestinal endoscopy. Patients were divided into Group FP (n=30), who received fentanyl–propofol, and Group FD (n=30), who received fentanyl–dexmedetomidine. Heart rate, blood pressure, respiratory rate, peripheral oxygen saturation, adverse events, time to regain consciousness, and time to discharge were recorded and compared between the groups. Results: Baseline demographic and clinical characteristics were comparable between the groups. The overall mean heart rate was significantly higher in Group FP than Group FD (86.4 ± 9.7 vs. 75.2 ± 8.1 beats/min), p<0.001, while overall blood pressure parameters were comparable. Group FD demonstrated a significantly higher respiratory rate (15.3 ± 2.1 vs. 14.1 ± 2.5 breaths/min), p=0.04, and peripheral oxygen saturation (97.8 ± 1.0% vs. 96.2 ± 1.8%), p<0.001. Bradycardia was significantly more frequent in Group FD (26.7% vs. 3.3%), p=0.01. Recovery was significantly faster in Group FP, with shorter time to regain consciousness (7.5 ± 2.8 vs. 12.6 ± 4.3 minutes) p<0.001 and time to discharge (25.4 ± 7.1 vs. 35.8 ± 9.5 minutes) p<0.001. Conclusion: Both regimens provided effective intravenous anaesthesia for upper gastrointestinal endoscopy. Fentanyl–dexmedetomidine was associated with lower heart rate and better respiratory parameters but a higher incidence of bradycardia and prolonged recovery. Fentanyl–propofol provided faster recovery and earlier discharge.

Keywords: Dexmedetomidine, Fentanyl, Propofol, Upper Gastrointestinal, Endoscopy, Intravenous Anaesthesia, Sedation.