Benzodiazepines have a depressant effect on the respiratory system, and have a risk of paradoxical reactions. In addition you’d need a heroic dose to cause total sedation, so a benzo is usually only a component of along with an opiate to induce “twilight” sleep. For the purposes of this dive obviously respiratory depression was unacceptable, and doubling down with an opiate would have been worse.

Ketamine is very safe, and some nasty side effects are preferable to death.

Benzodiazepines require heroic doses before they start to depress respiration. At low doses, like what you’d use to keep someone calm, it’s a non-issue.

Not sure why you’d want them so sedated that they are semiconscious.

It doesn’t take much to keep someone from freaking out.

It would take quite a large doze of benzos to keep someone calm enough to drag them underwater through a cave when they can't swim.

You'd also want to stop them from moving about and potentially causing trouble.

The whole point was to fully anesthetize them, not merely sedate them. The risk that they’d panic or become disoriented was too great.

Seems like overkill to me! I’ve seen people given reasonable doses of benzodiazepines be quite compliant!

Compared to ketamine, benzodiazepines are far more likely to cause respiratory depression and arrest, as well as airway obstruction due to relaxation of muscles and soft tissues in the jaw and neck. I am a retired neurosurgical anesthesiologist (38 years experience) and used ketamine — both IV and IM — hundreds of times in the OR in children and adults.

Well you obviously know more than I do, but I guess my question is - were these kids anesthetized?

If so, I would agree ketamine is much safer. But if you’re just trying to keep them from freaking out, 5mg is diazepam will do the job and respiratory depression isn’t much of an issue.

Yes, the kids in the cave were anesthetized. Diazepam is NOT an anesthetic: it is an anxiolytic/hypnotic/sedative. 5mg of diazepam will calm some, put others to sleep, and not noticeably affect others. Variation in response is huge. With ketamine, a given mg/kg dose is far more predictable.

Use of benzos in distressing situations is linked to PTSD.

What are the unpleasant effects?

A psychedelic experience basically, why people take it recreationally in doses that don't quite knock you out. It's really bizarre and something best not experienced submerged in a cave.

I was taught 20 years ago that it was still given to children as an anaesthetic because it's very safe and they tend to either not experience the "trip" or are not bothered by it, thinking it's a dream.