Comparison of Anesthetic Features in Diazepam and Midazolam for Sedation Dentistry: A Scoping Review

In recent years, there have been incidences of shortages of sedatives due to infectious diseases and supply issues. Dental anesthesiologists are required to have backup plans in case of supply shortages. Therefore, the aim of this study was to highlight the characteristics of diazepam and compare them with those of midazolam, and to explore the possibility of proposing useful situations for the use of diazepam in the modern intravenous sedation (IVS) scene. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Literature research was performed using PubMed and Google Scholar. After a detailed scrutiny, 20 English-language studies comparing midazolam and diazepam met the eligibility criteria. The evaluation points were classified into four categories: onset of action, recovery from sedation, injection pain, and amnesic effects. The results of this analysis review highlight that diazepam tends to have (a) a slower onset of action and recovery, (b) more injection pain, and (c) a weaker amnesic effect compared with midazolam, and that diazepam has to be administered at higher doses compared with midazolam. The use of two drugs in combination (e.g., midazolam + propofol) is now a common practice due to the advances in anesthetic drugs. In addition, dentistry has become more advanced and involves lengthy procedures, such as implant surgeries. Therefore, it is necessary to focus on the optimal drug dosages in the combination of diazepam and propofol, the postoperative recovery time, and the presence or absence of injection pain and amnesic effects. Diazepam may be an alternative to midazolam for IVS during prolonged dental procedures in situations of shortage and requires further study.