Epidural Anesthesia for Sympathetic Overactivity in Severe Tetanus

Diretrizes para o manejo do tétano acidental em pacientes adultos

“…(78,80,81,97,113,122) Several reports describe that epidural administration of such agents as bupivacaine with the creation of a continued epidural blockade may contribute to the management of autonomic dysfunction. (98,123,124) However, the role of this therapy is uncertain.…”

Tetanus Toxin

“…25,27,84 Intravenous labetalol has been commonly recommended due to its combination of ␤and ␣-antagonist activity. 25,31,90 Other supportive care 91,92 includes proper nutrition, with a recommended caloric intake of 3500 to 4000 calories with more than 150 g of protein via a percutaneously placed gastrostomy tube due to the increased metabolic demand from constant muscular contractions. Morphine and fentanyl also act centrally by decreasing the sympathetic outfl ow with subsequent control of hypertension and tachycardia, 27,30 along with additional sedation.…”