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Abstract

Background: Sedation is an essential aspect of mechanically ventilated patient management in the Intensive Care Unit (ICU). Selection of the sedative agent may have a major impact on the outcome of patients. This trial seeks to compare the safety and efficacy of dexmedetomidine and midazolam in anesthesia-related sedation in mechanically ventilated ICU patients. Methods: A randomized controlled trial was carried out in Lady Reading Hospital, Peshawar, on 100 adult mechanically ventilated ICU patients. Participants were randomly allocated to be administered either dexmedetomidine or midazolam. The depth of sedation was measured by Richmond Agitation-Sedation Scale (RASS), and measures like time to extubation, mechanical ventilation duration, ICU stay, need for opioids, and delirium incidence were documented and analyzed. Results: Dexmedetomidine-sedated patients had superior RASS control, had much reduced mechanical ventilation and ICU stays, and had fewer ICU-associated delirium events than midazolam-treated patients. The dexmedetomidine group also needed less opioid supplementation. Bradycardia was more prevalent in the dexmedetomidine group but was controllable with titration of doses. Conclusion: Dexmedetomidine was found to be superior and safer than midazolam for sedation of mechanically ventilated ICU patients. Its application may improve recovery, decrease ICU burden, and enhance global patient outcomes, especially under resource-scarce conditions.