An article titled “Anesthesia Complications of Diazepam Use for Adolescents Receiving Extraction of Third Molars,” appears in the 2016 Journal of Oral and Maxilofacial Surgery by Gino Inverso and et. al, vol. 74, pp. 1140-1144. The article seeks to evaluate the safety of midazolam and diazepam for adolescents during wisdom teeth extraction and whether any differences in complications exist when using the 2 benzodiazepines alone or in combination. Compared with diazepam, midazolam has a faster onset of action, greater incidence of amnesia, and shorter recovery time. The authors hypothesized that diazepam, when used as an intravenous sedative agent for third molar extraction, would be associated with a higher rate of anesthetic complication than midazolam.
The study included patients enrolled in the OMSOS from January 2001 through December 2010. To be included, patients had to be adolescents (<21 yr old) who underwent at least 1 third molar extraction by an oral and maxillofacial surgeon in the ambulatory setting. The study cohort was divided into 3 groups: patients who received diazepam as the only parenteral benzodiazepine, patients who received midazolam as the only parenteral benzodiazepine, and patients who received a combination of diazepam and midazolam. The primary outcome was perioperative anesthetic complications. Complications included vomiting, laryngospasm, bronchospasm, respiratory arrest, hypoventilation requiring intervention, new cardiac dysrhythmia requiring intervention, syncope, seizure, neurologic impairment, prolonged emergence from anesthesia, and peripheral vascular injury. In addition, any hospitalization or death resulting from an anesthetic complication was noted.
In total, 18,090 patients met the inclusion criteria for the study. The average age was 17.2 plus or minus 2.3 years. In total, 194 perioperative complications (1.1%) were reported. The most common complications were vomiting without aspiration during recovery (0.3%), peripheral vascular injury (0.2%), and syncope (0.1%). Complication rates for the diazepam and combination groups were 1.4%, whereas the midazolam group had a complication rate of 1.0%. After adjusting for patient demographics, perioperative factors, and additional anesthetics used during the procedure, multiple logistic regression analysis showed that patients administered diazepam had a 50% increased odds of an adverse complication compared with those who received midazolam as the sole parenteral benzodiazepine.
In the diazepam cohort, the most common complication was vomiting without aspiration during recovery, occurring at an incidence of 0.5%.
The authors provide a series of limitations of this study. The authors end by concluding
“Despite these limitations, this study identified a higher odds ratio of perioperative anesthetic complications with the use of intravenous diazepam compared with midazolam for outpatient third molar removal in adolescent patients. Future studies will evaluate the safety profiles of other commonly used anesthetic agents”