BackgroundDuring awake fiberoptic intubation, propofol, ketamine, benzodiazepines, opioids and dexmedetomidine are most commonly used, alone or in combination for sedation. The aim of this study was to compare the clinical efficacy of dexmedetomidine with alfentanil as a sole agent for patient-controlled sedation during fiberoptic intubation. MethodsSixty adults patients aged 30–55 years undergoing urologic surgery, were randomly allocated into two equal groups (n = 30) to receive either a loading dose of dexmedetomidine (1 μg/kg) over 10 min, followed by 0.5 μg/kg/h infusion or alfentanil a loading dose (20 μg/kg) over 60–90 s and then repeated 10 μg/kg every 1–2 min over 10–20 s to reach Ramsay Sedation Scale≥ 3. Primary outcome measures were intubation scores as assessed by vocal cord movement, limb movement, patient tolerance, cough, and patient cooperation immediately after intubation. Other parameters included time taken to achieve sedation, endoscopy time, intubation time and hemodynamic changes during this procedure. Patients’ satisfaction score with the procedure was also evaluated postoperatively. ResultsTime taken to achieve sedation, endoscopy time, intubation time in the alfentanil group was significantly shorter than the dexmedetomidine group (p ≤ 0.001). Limb movement and cough were more suppressed among the alfentanil group (p < 0.0001). Alfentanil provided better patient satisfaction than dexmedetomidine (p < 0.007). The level of patients’ tolerance and cooperation during and immediately after intubation were higher in the alfentanil group comparing dexmedetomidine (p < 0.0001 and p < 0.005; respectively). Nine patients in the dexmedetomidine group and two patients in the alfentanil group needed to be administered atropine (p < 0.02) to increase the heart rate, and four patients in the dexmedtomidine group and no patients in the alfentanil group needed ephedrine to increase their heart rate and blood pressure. Mean arterial pressure in the alfentanil group was significantly more stable than in patients who received dexmedetomidine (p, 0.0001). ConclusionsAlfentanil provided significantly more stable intubation scores for awake fiberoptic intubation compare with dexmedetomidine and patients were significantly more satisfied with fewer hemodynamic adverse effects.