Sedation is the main concern to ventilate the patient in icu. As there are many agent and combination used in ICU for sedation by an intensivist,so all drugs combination have some advantages and disadvantages. Dexmedetomidine is used as sedative and alpha2 adrenergic agonist and its haemodynamic effect is that it causes bradycardia and hypotension while ketamine used as sedative causes tachycardia and hypertension. Midazolam is also used as sedation in combination with opiod fentanyl. We used combination of dexmedetomidine and ketamine to neutralize the effect of each other and to have balanced haemodynamics and sedation in icu patient.