Efficacy of concomitant use of dexmedetomidine and propofol in tetanus

Miya, Ken; Shimojo, Nobutake; Koyama, Yoshinori; Enomoto, Yuki; Hagiya, Keiichi; Yamasaki, Yuichiro; Nishino, Tomofumi; Kawano, Satoru; Mizutani, Taro

doi:10.1016/j.ajem.2015.04.069

Cited by 9 publications

(7 citation statements)

References 7 publications

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“…In contrast, the administration of propofol revealed excellent anti-spasm effects. Likewise, several reports [ 13 – 15 ] also confirmed the efficacy and safety of propofol in management of tetanus, suggesting that propofol may be a promising choice of pharmacological management of severe tetanus. In addition, the tracheotomy performed for this patient seemed to be redundant, for that the generalized stiffness and laryngospasm were not any more encountered during the afterwards treatment and that MV therapy was removed in the next day.…”

Section: Discussionmentioning

confidence: 81%

Severe tetanus following ulcerated skin cancer

Wang

Yang²,

Yang

et al. 2020

Medicine

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Rationale: Tetanus is usually caused by wound infection with Clostridium tetani after acute injuries. Skin cancer wound is a rarely reported cause of tetani infection. It is difficult to be diagnosed and mistaken for other brain lesions. Patient concerns: A 49-year-old man presenting with the only symptom of repeated convulsions was admitted to our department. He had an ulcerated skin cancer on the right buttock that had been excised in another hospital 1 month before admission, leaving the wound unhealed. He was suspected of having a metastatic brain tumor early, but exhibited a negative cranial CT-scan. Diagnosis: Tetanus was diagnosed when he was observed to have sudden convulsions after sensory stimulation such as noise, light, or touch. Interventions: Despite administration of a high dose of diazepam and phenobarbitone, continuous generalized rigidity with laryngospasm still occurred. Instead, when propofol was intravenously infused, the spastic convulsion completely stopped. Tracheotomy and mechanical ventilation were performed. Outcomes: The patient gradually recovered in 2 weeks. Lessons: Tetanus is rarely infected through the wound of an ulcerated skin cancer. Early diagnosis can only be based on accurate assessment of clinical manifestations, and propofol infusion appears to be more effective in anti-convulsion management for patients with tetanus. Routine vaccination to prevent tetanus in patients with ulcerated skin cancer should be considered in the future clinical work.

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Section: Discussionmentioning

confidence: 81%

Severe tetanus following ulcerated skin cancer

Wang

Yang²,

Yang

et al. 2020

Medicine

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“…The combined use of propofol and dexdor, described by a team of authors, also demonstrated efficacy in the treatment of convulsive syndrome and autonomic disorders without the use of muscle relaxants and other anticonvulsants [22].…”

Section: Research Results and Discussionmentioning

confidence: 99%

Current Concepts in the Management of Tetanus

Tkachenko

Shkatula

Badion

et al. 2020

EUMJ

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The study focuses on the problem of severe tetanus cases, which continue to be reported worldwide. The population of countries with low vaccination rates, including Ukraine, is particularly at risk. Despite the increase in the level of DPT vaccination in our country among adults and children, it remains insufficient, which leads to the registration of new cases of tetanus. The aim of the study was to analyze the main directions in the treatment of tetanus. The authors searched for information in electronic databases such as MEDLINE/Pub Med and Google Scholar for the last 20 years. The search was performed on such terms as tetanus, treatment, benzodiazepines, tetanus immunoglobulin (medical topics). The main components of modern treatment are analyzed in the paper, which include removal of the pathogen by careful surgical treatment of wounds, rational antibiotic therapy. Drugs of choice for the eradication of vegetative forms of the pathogen are benzylpenicillin and metronidazole, but can also be used antibacterial drugs of other groups (macrolides, tetracyclines, cephalosporins). Specific immunotherapy with tetanus immunoglobulin can neutralize the toxin that freely circulates in the blood. Those who do not have vaccination data are also indicated for the introduction of tetanus toxoid. Intrathecal administration of anti-tetanus immunoglobulin remains a debatable issue. In the treatment of convulsions, drugs of the benzodiazepine group are preferred. Infusions of high doses of magnesium, dexmetomedin, baclofen, propofol or their combination can also be used. In the case of severe muscular rigidity, muscle relaxants of nondepolarizing action are used. If the spasms are prolonged, botulinum toxin A may be recommended as an injection into peripheral muscles. B-blockers (esmolol), dexmetomedin, clonidine are used to overcome autonomic dysfunction of the nervous system. Supportive therapy is important. It is aimed at providing the patient with complete nutrition. Adequate ventilation with early tracheostomy helps to avoid complications of prolonged intubation. The above methods can significantly reduce mortality from tetanus from 100% (in the absence of treatment) to 10%–20%. Keywords: tetanus, management, benzodiazepines, magnesium sulfate, tetanus immunoglobin, tracheostomy.

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“…Recently, anecdotal information from single-case reports or case series have demonstrated the potential utility of dexmedetomidine (0.2-0.7 µg/kg/hr) to control muscle spasms and autonomic dysfunction. 8,9 Remifentanil is a selective mu-opioid receptor agonist, which has a rapid onset of action and is metabolized by non-specific ester hydrolysis in the blood and tissues. 10 During surgical procedures, noxious stimuli and surgical incision may precipitate muscle spasms and autonomic dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, anecdotal information from single-case reports or case series have demonstrated the potential utility of dexmedetomidine (0.2–0.7 µg/kg/hr) to control muscle spasms and autonomic dysfunction. 8 , 9 …”

Section: Discussionmentioning

confidence: 99%

Anesthetic Care During Tracheostomy in a Patient with Generalized Tetanus: A Case Report

Yoshida¹,

Yamaguchi²,

Matsushita³

et al. 2021

IMCRJ

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Tetanus is a potentially fatal infectious disease caused by the toxins produced by the anaerobic bacterium, Clostridium tetani. Of major concern during the perioperative care of these patients is control of muscle spasms, skeletal rigidity, and autonomic dysfunction. Several of the modern sedative and opioid agents including remifentanil have not been fully evaluated in managing tetanus. We present the intraoperative use of remifentanil in a 75-year -old woman with generalized tetanus who required anesthetic care during placement of a tracheostomy. The end-organ involvement of tetanus is presented, previous reports of anesthetic care reviewed, and the potential utility of remifentanil explored.

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Efficacy of concomitant use of dexmedetomidine and propofol in tetanus

Cited by 9 publications

References 7 publications

Severe tetanus following ulcerated skin cancer

Severe tetanus following ulcerated skin cancer

Current Concepts in the Management of Tetanus

Anesthetic Care During Tracheostomy in a Patient with Generalized Tetanus: A Case Report

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