ABSTRACT Background: Surgery of cochlear implantation is a great advance in otology for patients with deaf mutism, but it carries a great challenge to the anesthesiologist. Objective: The aim of the current work was to compare effect of bolus Dexmedetomidine infusion versus bolus Midazolam- fentanyl infusion as regards; emergence agitation & recovery time, hemodynamics, postoperative pain and complication. Patient and Methods: This study included a total of 40 pediatric patients (ASA I or II), undergoing cochlear implantation, attending at Sohag University Hospital. They were randomized divided into dexmedetomidine (D) group and midazolam (M) group. Results: There was no significant difference between both groups as regard intraoperative mean blood pressure. There was a significant difference at discharge time. There was statistically insignificant decrease in heart rate (HR) in group D than M group. There was statistically significant difference at 1 min and discharge measurements. There was a highly significant difference between both groups as the time for recovery being more rapid in D group than in M group. Mask Acceptance Scale (MAS) was better within D group than M group without statistically significant difference. There was a no significant difference in emergence agitation between both groups. There was no significant difference between both groups as regard objective pain score. As regard nausea and vomiting, there was a highly significant difference between both groups. Conclusion: It could be concluded that dexmedetomidine infusion in cochlear implantation in pediatric patients was equal as midazolam-fentanyl in inducing hypotension, emergence agitation and giving post-operative analgesia. However, dexmedetomidine infusion is better as regardrapid recovery without inducing nausea and vomiting.