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A 61year old male patient with generalized tetanus developed central depression due to combined use of magnesium sulphate, midazolam, morphine and fentanyl. He was successfully treated with magnesium sulphate (MgSO 4 ) infusion with the minimal usage of sedatives and paralytic agents. Lowering of GCS occurred on day 6, 7 and 8 indicating central depression.

This audit was conducted in a University Hospital in United Kingdom to determine whether tracheal tube cuffs were correctly inflated and to assess whether the cuff pressure was recorded routinely by the nursing staff in the ICU. 62.5% were within the recommended cuff pressure level. Of all the ICU recordings only 72% had recorded the cuff pressure according to the local protocol. Measurement and recording can be improved by adhering to the local protocol.