Background Midazolam, a class of benzodiazepines, is frequently administered to patients for clinical sedation. However, most doctors do not pay sufficient attention to paradoxical reactions related with midazolam. Objective To call attention to the paradoxical reactions induced by midazolam so as to improve the sedation quality of midazolam. Content This review introduces the concept, mechanism of paradoxical reactions, and analyses some possible factors. It also explores the advantages and disadvantages of the various available treatment options. Trend The exact mechanism of paradoxical reactions remains unclear. As more information is learned regarding the mechanism of paradoxical reactions, better treatment options may become available.