Treatment of severe tetanus by intrathecal injections of baclofen without artificial ventilation

Abstract

A study was conducted to evaluate repeated intrathecal injections of baclofen, without artificial ventilation, in the treatment of severe tetanus. Ten patients, 5 men and 5 women, with a mean age of 34 +/- 7 years, were included in the study. The dose of baclofen injected was 1000 micrograms between the ages of 16 and 55 years, 800 micrograms over the age of 55 years and 500 micrograms under the age of 16 years. The efficacy was assessed on the basis of the resolution of contractures and paroxysms and the initial dose was reinjected prior to the reappearance of these symptoms. Treatment was discontinued in the case of central nervous system depression or inefficacy. The first injection was effective in 9 cases for 24-48 h. The haemodynamic safety was always good. Five patients developed central depression with coma and respiratory depression, requiring artificial ventilation in 3 cases and reversed by flumazenil in 2 cases. Five patients were treated exclusively with baclofen with 4 cures. Five patients had to be ventilated with only one cure. This study confirms earlier studies concerning the efficacy of intrathecal baclofen in tetanus. However, the frequency of episodes of respiratory depression prevents the recommendation of repeated injections when respiratory intensive care facilities are not available.

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.…”

Tratamiento del tétanos con baclofeno intratecal

“…Se caracteriza por cambios en el estado mental, en las funciones motoras y autonómicas. Síntomas debidos a un exceso de serotonina con estimulación de los receptores serotoninérgicos centrales y periféricos (8).…”

Behandlungsstrategien des Tetanus

“…Auch das bereits genannte Baclofen zeigte zumindest in einer Fallserie einen Effekt in der Kontrolle der kardiovaskulären Instabilität, jedoch waren auch diese Ergebnisse nicht reproduzierbar [15,26,32]. Zudem bleiben die Nachteile der notwendigen intrathekalen Applikation.…”