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.
Highlights
Our object is to raise the feasibility of titration of high dose sedatives in the management of severe tetanus
We report one case of severe tetanus
The patient recovered while no complications remained. This case report indicated that combination and high dose of sedation for severe tetanus were feasible
Summary
Tetanus is an acute fatal infectious disease which is caused by Clostridium tetani. The source of the infection is the contaminated wound, which often remains unidentified. On 25th day in ICU, the pneumonia was controlled (Figure 2), spasticity and rigidity subsided, and no severe complications occurred, but sedatives were still needed [propofol (50 mg/h), midazolam (20 mg/h), vecuronium bromide (4 mg/h)]. In this condition, we decided to withdraw the sedatives gradually. Fluctuations of blood pressure and heart rate, the dosage of propofol and midazolam were reduced gradually. Spasms subsided gradually both in frequency and severity which allowed the reduction of their infusion rates.
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