Background Sedation for the coblation-assisted upper airway procedure has lacked easy modulation between appropriate pain control and airway protection.This study aimed to compare the effectiveness of dexmedetomidine versus target controlled propofol infusion in providing sedation during a coblation-assisted upper airway procedure.Methods In a prospective,randomized trial,60 adult patients with obstructive sleep apnea syndrome due to undergoing a coblation-assisted upper airway procedure were enrolled and randomly allocated to receive dexmedetomidine,1.0 μg/kg over 10 minutes and maintain dosage 0.7 μg·kg-1·h-1 (n=30) or propofol target controlled infusion (n=30).Satisfaction with the analgesia and tolerance of the procedure by the patient,as assessed by a visual analogue scale,were evaluated as primary outcomes.Cardiopulmonary parameters and some side effects were monitored and recorded.Results Both groups of 30 patients had comparable demographics and initial parameters.Patients in the propofol group reported more pain (P ＜0.05),tolerated the procedure less well (P ＜0.05),and were less satisfied with the different stages of procedure (P ＜0.05 or P ＜0.01).Changes in mean arterial pressure and heart rate were more dramatic in the propofol group (P＜0.05).The dexmedetomidine group experienced fewer airway events and less respiratory depression than did the propofol group.Conclusion Dexmedetomidine in conjunction with local anesthesia offered better analgesia and conscious sedation for a coblation-assisted upper airway procedure as well as less airway obstruction,apnea and greater haemodynamic stability.