Inclusion Criteria:  elective transurethral resection of bladder and prostate American Society of Anesthesiologists (ASA) physical status classification system: I, II, III  Exclusion Criteria:  regional anesthesia contraindications American Society of Anesthesiologists (ASA) physical status classification system: IV Atrioventricular cardiac block II and III degree Psychotic disorders Participants with tracheostomy Dementia Allergy on Dexmedetomidine or Midazolam