Profound central depression during treatment of tetanus with combined magnesium, midazolam, morphine and fentanyl

Abstract

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.

Magnesium sulphate as firstline and mainstay therapy without sedation in the management of a patient with tetanus

“…This combination could be life threatening. 4 Recent intensive care guidelines highlight the value of a conscious, co-operative patient to avoid the dangers of heavy sedation, and magnesium therapy for tetanus has been highly recommended. 5 We report the successful management of grade III tetanus with magnesium as mainstay therapy without sedation.…”