<![CDATA[Background: Sedation in neurocritical care must provide adequate comfort and ventilator tolerance while preserving neurological assessment and minimizing hemodynamic instability. Dexmedetomidine, propofol, and midazolam are widely used, but their comparative effects on clinically important outcomes remain uncertain. This systematic review and meta-analysis aimed to evaluate whether dexmedetomidine improves hemodynamic outcomes, intensive care unit (ICU) length of stay, and duration of mechanical ventilation.Methods: This systematic review and meta-analysis included randomized controlled trials and observational studies involving adult neurocritical care patients that compared dexmedetomidine with propofol or midazolam, reported hemodynamic outcomes, ICU length of stay, or duration of mechanical ventilation. We pooled continuous outcomes as mean differences (MDs) and categorical outcomes as odds ratios (ORs), with 95% confidence intervals (CIs).Results: Of 2,113 records identified, nine studies met the eligibility criteria. Compared with propofol, dexmedetomidine showed no significant difference in bradycardia (OR 2.72; 95% CI 0.62–11.93; p=0.18), hypotension (OR 0.89; 95% CI 0.64–1.25; p=0.51), or mean arterial pressure change (MD 1.12; 95% CI −5.11 to 7.35; p=0.72). ICU length of stay was similar versus propofol (MD −3.21 days; p=0.40) and midazolam (MD −5.97 days; p=0.09). Mechanical ventilation duration was also not significantly reduced versus propofol (MD −1.36 days; p=0.08) or midazolam (MD −2.00 days; p=0.22).Conclusion: Dexmedetomidine showed no significant superiority over propofol or midazolam in neurocritical care. Sedative selection should therefore be individualized according to neurological status, hemodynamic profile, ventilation requirements, and patient-specific risks.]]>
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