Dexmedetomidine sedation for the treatment of tetanus in the intensive care unit

Perioperative care of a child with tetanus

“…22 Although dexmedetomidine did not completely control the paroxysms, it did reduce their frequency and severity, as well as the need for sedative, analgesic and neuromuscular blocking agents. In our patient, treatment was initiated with intermittent doses of morphine and diazepam, which failed to control the muscle spasms effectively, and therefore a dexmedetomidine infusion was started.…”

“…Anecdotal success has been reported with the α 2 -adrenergic agonists clonidine and dexmedetomidine. 21,22 Direct-acting vasodilators of the dihydropyridine class of calcium-channel antagonists, such as nicardipine, have also been used to control hypertension in patients with tetanus. However, given its duration of action, excessive hypotension may occur.…”

Diretrizes para o manejo do tétano acidental em pacientes adultos

“…However, several methodological limitations limit any conclusions, even in the pediatric population. Several case reports and case series have been published using other treatment schedules, e.g., intrathecal baclofen, (71)(72)(73)(74)(75)(76) dexamedetomidine (77) or midazolam with or without propofol, (78,79) or propofol alone. (80,81) Experience with diazepam is more extensive, supporting it as the first choice of a muscle relaxant until appropriate studies can be conducted.…”

“…Data on the use of dexmedetomidine, another alpha-2-agonist, are restricted to anecdotal reports. (77,107) The use of beta-blockers is controversial and has been associated with sudden death, probably due to betablockade with alpha-adrenergic activity release. The use of beta-blockers is not recommended.…”

Efficacy of concomitant use of dexmedetomidine and propofol in tetanus

“…The efficacy of clonidine, an α-2-adrenoreceptor agonist, has been well discussed in literature, and association of its use and decreased mortality was suggested [6]. Dexmedetomidine, which is a commonly used sedative agent in Japan currently due to its safety and excellent efficacy, has higher affinity to adrenaline α-2 receptor than clonidine and reported to suppress sympathetic activity in normal subjects [7] as well as to stabilize heart rate and blood pressure in patients with tetanus [8]. Given these results, although further studies are necessary, it seems that dexmedetomidine is effective to control autonomic instability in tetanus.…”