We experienced two esophageal ESD cases in which intraoperative introduction of dexmedetomidine (DEX) was useful for poor responders to conventional sedation mainly by flunitrazepam. The patients having a large, superficial esophageal cancer were referred to our hospital for endoscopic resection. We started ESD with flunitrazepam and pethidine hydrochloride which had been effective on preoperative endoscopy. During the procedure, they moved frequently, and additional injection of flunitrazepam, midazolam, and pethidine hydrochloride was ineffective. Therefore, we decided to switch the sedation to continuous infusion of DEX. After using DEX, favorable sedation was obtained and vital signs including respiratory function became stable. Finally, we could complete the procedure without complications.
