-125 - 破傷風に対する芍薬甘草湯 AbstractSuccessful treatment of tetanus using the herbal medicine shakuyakukanzoto: a report of three cases Tetanus can rapidly develop into muscle spasm accompanied by respiratory failure and result in fatal outcomes. Although the management of muscle spasticity and rigidity is of great importance, there is no consensus on the best treatment modality. Recently, the herbal medicine shakuyakukanzoto has been reported to be effective for the treatment of the muscle disorder in 2 patients with tetanus. Here, we report a comparison of 3 cases of tetanus that were successfully treated with shakuyakukanzoto with 3 cases treated without shakuyakukanzoto. All patients with tetanus presented with neck stiffness, dysphagia, and trismus, and received intravenous anti-tetanus human immunoglobulin and penicillin G with or without the oral administration of shakuyakukanzoto. Improvements in muscle spasticity and rigidity were found only in patients with shakuyakukanzoto, and not in those treated without: the latter needed to be managed with mechanical ventilation. Shakuyakukanzoto may be useful for the treatment of muscle spasticity and rigidity in patients with tetanus.

Background: In recent years, the assessment and guidance of cardiopulmonary resuscitation (CPR) quality using noninvasive and invasive monitoring techniques have been increasingly recommended. In this study, we introduce a new physiological monitoring system that simultaneously measures arterial pressure (AP), venous pressure (VP), and cerebral tissue oxygen saturation (SctO2) during CPR. Methods: This prospective observational study was conducted at a single center (Kagoshima City Hospital). Adult out-of-hospital patients aged ≥18 years with an intravenous femoral arterial line, venous line, and SctO2 monitor were included. We measured femoral arterial pressure (FAP) and femoral venous pressure (FVP) invasively if catheters were immediately inserted into the femoral artery and vein for potential candidates who require interventions such as extracorporeal cardiopulmonary resuscitation but did not receive such interventions as a result. Results: We observed several representative cases that provided the following insights: We presented several cases, including two patients with significant increases in FVP and low SctO2 values, and in both cases, return of spontaneous circulation (ROSC) was not achieved. In contrast, we also presented two cases in which CPR resulted in higher FAP compared to FVP and an upward trend in SctO2 values was observed, and both instances achieved ROSC. Conclusion: We presented a simultaneous physiological monitoring system that can monitor AP, VP, and SctO2 during CPR. Further case accumulations will be necessary to assess the variations in hemodynamic status during CPR and the association between each hemodynamic status and outcomes after cardiac arrest.