A few patients may show paradoxical arousal or excitement following administration of a barbiturate rather than the expected hypnotic effect.
Risk factors:
(1) geriatric patient
(2) debilitated patient
(3) type of barbiturate used (associated with Phenobarbital or N-methylbarbiturates)
(4) history of a paradoxical reaction to barbiturates in the past
Clinical effects:
(1) arousal, excitement or restlessness
(2) appearance of being inebriated
Milam and Bennett found that low-dose physostigmine (1 mg for 70 kg adult) reduced drug-induced excitement. Higher doses may be associated with delirium, bradycardia and other side effects.
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