Adjunctive Use of Dantrolene in Severe Tetanus

NEUROLOGICAL ASPECTS OF TROPICAL DISEASE: Tetanus

“…The directly acting muscle relaxant dantrolene has been reported in one case in which spasms were difficult to control. Paralysis was unnecessary after administration of dantrolene, spasms reduced, and patient condition improved 49. The sedative agent propofol may also have useful muscle relaxant properties.…”

Tetanus

“…(Demaziere et al 1991) (Tidyman et al 1985). However, their use is not widespread, and as baclofen must be administered intrathecally, its use is restricted to centres with suffi cient facilities to perform this safely.…”

Correspondence

“…The treatment of pain following craniotomy in most neurosurgical centres in the UK consists ofcodeine phosphate intramuscularly [1] and has been shown to be less than ideal [1][2][3]. Codeine is demethylated in the liver to its active form, morphine [4] and, in addition, transformation may also occur in the brain [5]. So at least part of the analgesic effect ofcodeine is due to its metabolism to morphine.…”

“…As a result paediatricians have been reluctant to use the brachial artery and there is a dirth of information in the literature on brachial artery catheterisation in children and we could find no references on Medline to this technique. Paradoxically, the complications associated with radial artery catheterisation [3][4][5][6] have not deterred their continued use nor continued recommended use [1]. The brachial artery is subcutaneous and therefore most accessible in the antecubital fossa medial to the insertion of the biceps tendon; these are the surface marking used to locate the artery.…”

“…Previous reports of dantrolene use in tetanus reported in the literature are rather sparse. It was generally administered in relatively mild cases, or in the convalescent phase of the disease [3][4][5][6][7]. To our knowledge, the early intravenous administration of dantrolene suggested by Tidyman et al [5] had been reported only by Sternlo & Andersen [7] and Checketts & White [1].…”