Titration of high dose sedation is effective in severe tetanus: a case report

Abstract

IntroductionTetanus is a fatal infectious disease. It could cause typical signs like pain, headache, stiffness, and spasms of facial muscles as well as trunk and skeletal muscles. The symptoms are risus sardonicus, trismus and opisthotonus. How to control the spasticity and rigidity of muscles is still a problem. Our object is to raise the feasibility of titration of high dose sedatives in the management of severe tetanus.Case presentationA 37-year-old woman was sustained a 2 cm wound in the right anterior part of chest. Then she developed progressive risus sardonicus, trismus and opisthotonus, elevated liver enzymes, creatine kinase, lactic acid and myoglobin. The patient was treated with continuous infusion of propofol (50-100 mg/h, 22 days) and midazolam (5-20 mg/h, 37 days) for sedation, vecuronium (1-6 mg/h, 25 days) for muscle relaxation. The symptoms of tetanus were controlled, and there were no side-effects appeared.ConclusionWe report one case of severe tetanus. In this case, several types of sedative were administrated and most of them were high doses. The patient recovered while no complications remained. This case report indicated that combination and high dose of sedation for severe tetanus were feasible. We recommend this treatment as the guidance of similar patients.

Pharmacological management of tetanus: an evidence-based review

“…The rates of survival with this practice have improved over the years with better ICU facilities and ventilatory options, as demonstrated by a comparative analysis of two case series in Australia [ 11 ]. Sedatives used vary from benzodiazepines such as midazolam and diazepam to anesthetic agents such as propofol [ 12 - 14 ]. Phenothiazines such as chlorpromazine are also used for sedation in resource-limited settings.…”

Botulinum Neurotoxin Injections in Childhood Opisthotonus

“…Maple syrup urine disease [17] Meningitis [18,19] Monoamine neurotransmitter defect [20,21] Encephalitis [22,23] Wilson disease [24] Tetanus [1,[25][26][27][28] Neurodegeneration with brain iron accumulation (NBIA), e.g., pantothenate kinase-associated neurodegeneration (PKAN) [15] Rabies [29] Other genetic disorders 1 [21,30] Neurosyphilis [31] Cerebral malaria [12] Toxins/elevated toxic metabolites Kernicterus [12] Strychnine [32] Phencyclidine [32] Phenothiazines [32] Propofol [33,34] Methoxphenidine [35] Neonatal caffeine overdose [32] Increased Intracranial Pressure Subarachnoid hemorrhage [5] Intracerebral hemorrhage [5] Hydrocephalus [36] Mass/Tumor [36] Autoimmune…”

Neonatal Tetanus: case report in Saudi Arabia

“…Benzodiazepines midazolam and diazepam and anesthetic agents such as propofol are used as sedatives [28,29]. Benzodiazepines [30], which enhance the effect of GABA on the GABA A receptors of lower motor neurons and causes combination of muscle relaxant, anticonvulsant, sedative and anxiolytic effects. Okoromah and Lesi proved that using diazepam was related with better survival rate in children when compared to a combination of phenobarbitone and chlorpromazine (relative risk for death 0.36, 95% confidence interval 0.15 to 0.86: risk difference −0.22, 95% confidence interval −0.38 to −0.06).…”