Background: Sedation is an essential component of postoperative intensive care management to ensure patient comfort, facilitate mechanical ventilation, and prevent stress-related complications. Dexmedetomidine and propofol are commonly used sedative agents, each with distinct pharmacological profiles. However, their comparative efficacy and safety in ICU sedation remain an area of ongoing evaluation. Aim: To compare the efficacy and safety of dexmedetomidine and propofol for postoperative sedation in ICU patients. Methods: This prospective randomized comparative study was conducted in the ICU of Sree Mookambika Institute of Medical Sciences from June 2025 to March 2026. A total of 300 postoperative patients aged 18–65 years, requiring ICU stay of more than 24 hours, were enrolled and randomly assigned into two groups of 150 each. Group A received dexmedetomidine infusion (loading dose 1 mcg/kg over 10 minutes followed by 0.2–0.7 mcg/kg/hour), while Group B received propofol infusion (bolus 1–2 mg/kg followed by 2–5 mg/kg/hour). Sedation was assessed using the Richmond Agitation-Sedation Scale (RASS), with a target range of −2 to +1. Hemodynamic parameters and adverse events were monitored. Results: Baseline characteristics were comparable between both groups (p > 0.05). Mean RASS scores at different time intervals (0–24, 24–48, and 48–72 hours) showed no significant differences between dexmedetomidine and propofol groups (p > 0.05). The percentage of time within target sedation range was similar (87% vs 85%, p = 0.312). Hemodynamic parameters remained stable in both groups. The incidence of adverse events such as bradycardia, hypotension, and respiratory depression was low and comparable, with no statistically significant differences observed. Conclusion: Dexmedetomidine and propofol are equally effective and safe for postoperative ICU sedation, providing comparable sedation quality, hemodynamic stability, and minimal adverse effects. The choice between the two agents may be based on clinical judgment and individual patient factors.

Dexmedetomidine, Propofol, ICU sedation, RASS, Postoperative care, Hemodynamic stability