May cause hypotension. Use with caution in hemodynamically unstable patients (hypotension or shock). May cause laryngospasm or bronchospasms (use with extreme caution in reactive airway diseases (asthma or COPD)). May cause paradoxical responses, including agitation and hyperactivity, particularly in acute pain and pediatric patients. May cause respiratory depression (use with caution in respiratory disease). Use with caution in Addison’s disease (may prolong or potentiate hypnotic effect). Use with caution in severe anemia (may prolong or potentiate hypnotic effect), in unstable aneurysms, in cardiovascular disease, in hepatic impairment, myasthenia gravis, myxedema, and renal impairment (may prolong or potentiate hypnotic effect), and in history of drug abuse (potential for drug dependency exists). Effects with other sedative drugs or ethanol may be potentiated. Use with caution in debilitated patients, and in excessively premedicated patients (may prolong or potentiate hypnotic effect). Do not administer in acute pain. Repeated dosing or continuous infusions may cause cumulative effects. Extravasation or intra-arterial injection causes necrosis due to pH of 10.6. Anticonvulsants should not be discontinued abruptly due to possibility of increasing seizure frequency.