Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 05 11 1503 1503 Mohamed Selim Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt. Sameh Elaidy Anesthesia Department, Theodor Bilharz Research Institute, Giza, Egypt. Nabawya Kamal Anesthesia Department, Theodor Bilharz Research Institute, Giza, Egypt. Waleed Hamimy Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt. 2025 11 26 2025 12 01 Background: Propofol sedation is the most common method used in advanced upper gastrointestinal endoscopies, despite its short recovery time, narrow therapeutic window, and possible complications like desaturation and hypotension. Dexmedetomidine can replace or supplement propofol because it is a sedative and analgesic with little respiratory depression. Methods: 44 patients were randomly allocated to 4 groups; each received a different loading dose of dexmedetomidine in combination with propofol. A targeted controlled infusion was guided by the bispectral index. Hemodynamics and recovery times were measured to reach the optimum regimen that produces significant propofol sparing while minimizing the side effects of both components & avoiding substantial delays in recovery. Results: The 0.5 µg/kg dose of dexmedetomidine can co-produce adequate propofol-sparing sedation that is superior to 0.25 µg/kg of dexmedetomidine or using propofol alone, also with a lower rescue fentanyl dose, reduced overall propofol dosage, and higher endoscopist, anesthetist, and patient satisfaction scores without the higher incidence of dizziness and longer recovery time associated with the standard dose of 1 µg/kg. Conclusion: The 0.5 µg/kg dose of dexmedetomidine can produce adequate propofol-sparing sedation that is superior to 0.25 µg/kg doses of dexmedetomidine or using propofol alone, also with a lower rescue fentanyl dose, reduced overall propofol dosage, and higher endoscopist, anesthetist, and patient satisfaction scores without the higher incidence of dizziness and longer recovery time associated with the standard dose of 1 µg/kg. https://aacc.tums.ac.ir/index.php/aacc/article/view/1503