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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