Objective: This study compares the effects of infusion of Propofol-Remifentanil with Midazolam-Remifentanil in reducing bleeding in patients undergoing middle ear surgery. Methods: This study was conducted as a double blinded randomized clinical trial among 86 patients undergone elective surgery of the middle ear, they were divided in two 43 members group. All of the patients received Isoflurane and N 2 O as maintenance of general anesthesia. When entering the middle ear, in order to reduce bleeding and achieve surgeon's satisfaction, either the combination of Midazolam-Remifentanil (M-R) or the combination of Propofol-Remifentanil (P-R) was adjuvant in each group. The (M-R) group received 0.5-1 µg/kg/min Midazolam with intravenous infusion and (P-R) group received 50-100 µg/kg/min Propofol with intravenous infusion; 1.0 µg/kg/min Remifentanil was administered in both groups. Vital signs of the patients were measured and recorded in 5 minutes intervals during the surgical procedure. The BIS scores was monitored and recorded in each group. Satisfaction of the surgeon from surgical setting and the amount of bleeding was recorded based on the score 0-10. Results: There was no significant difference in systolic and diastolic blood pressure, mean arterial pressure (MAP), heart rate and BIS scores between the two groups during the procedure (P>0.05). Surgeon satisfaction showed no significant difference between the two groups (P>0.05). The differences between surgical procedure duration and period of PACU staying were statistically of no important significance between the two groups (P>0.05). Conclusion: It seems that in the middle ear procedures the combination of Propofol-Remifentanil and Midazolam-Remifentanil have not statistically significant differences in hemodynamic control, surgeon's satisfaction, duration of surgical procedure and discharge from PACU. Therefore, adjuvant drug selection might consider either of these two regimens in order to achieve better surgical condition. Further studies are recommended to confirm these findings. J o u rn al of A n e s th es ia & C li n ic a l Resea rc h