Comparing Sedatives for Intracranial Pressure Control in Traumatic Brain Injury

Inclusion Criteria: * Age ≥18 years * Moderate to severe traumatic brain injury with post-resuscitation Glasgow Coma Scale (GCS) ≤12 * Undergone urgent neurosurgical intervention (craniotomy, craniectomy, or ICP monitor placement) within 24 hours of injury * Admitted to ICU and expected to require continuous sedation * Hemodynamically stable or stabilized (defined as MAP ≥65 mmHg with vasopressor requirement ≤0.1 mcg/kg/min norepinephrine equivalent) * Informed consent obtained from legally authorized representative Exclusion Criteria: * The Relative refusal to participate in the research. * Known allergy or contraindication to propofol, midazolam, or dexmedetomidine * Pre-existing neurological disorders (epilepsy, prior stroke, brain tumors, dementia) that may interfere with outcome assessment * Severe hepatic dysfunction (Child-Pugh Class C) or acute liver failure * Severe renal dysfunction (eGFR \<30 mL/min/1.73m² or requiring renal replacement therapy) * Pregnancy or breastfeeding * Hemodynamic instability requiring norepinephrine \>0.1 mcg/kg/min or equivalent vasopressor support * Heart rate \<50 bpm or second/third-degree AV block without pacemaker (relative contraindication for dexmedetomidine) * Clinical determination of brain death or expected survival \<24 hours * Enrollment in another interventional trial * Severe polytrauma requiring ongoing surgical interventions that would interfere with protocol adherence