Ketamine in the management of generalised cephalic tetanus

Obanor, Osamudiamen O.; Osazuwa, Henry; Amadasun, J. E. O.

doi:10.1017/s0022215107001223

Cited by 7 publications

(4 citation statements)

References 14 publications

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“…Other case reports on the use of dantrolene are for milder grades of tetanus and demonstrate a successful outcome [55-57]. The use of ketamine along with intravenous diazepam is reported in one case report [58]. …”

Section: Results/reviewmentioning

confidence: 99%

Pharmacological management of tetanus: an evidence-based review

2014

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Tetanus is becoming rarer in both industrialized and developing nations due to an effective vaccination program. In 2010, the World Health Organization estimated there was a 93% reduction in newborns dying from tetanus worldwide, compared to the situation in the late 1980s. Due to its rarity, many diagnostic delays occur as physicians may not consider the diagnosis until the manifestations become overt. Without timely diagnosis and proper treatment, severe tetanus is fatal (mortality is also influenced by the comorbidities of the patient). The principles of treating tetanus are: reducing muscle spasms, rigidity and autonomic instability (with ventilatory support when necessary); neutralization of tetanus toxin with human antitetanus immunoglobulin or equine antitetanus sera; wound debridement; and administration of antibiotics to eradicate locally proliferating bacteria at the wound site. It is difficult to conduct trials on different treatment modalities in tetanus due to both logistical and ethical reasons. However, it is imperative that physicians are aware of the best evidence-based treatment strategies currently available to improve the outcome of patients. This review concentrates on analyzing the current evidence on the pharmacological management of tetanus.

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Section: Results/reviewmentioning

confidence: 99%

Pharmacological management of tetanus: an evidence-based review

2014

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“…Other than neuromuscular blocking agents, lorezapam, diphenhydramine and bentropine may show a benefit for relieving trismus [7]. One study also highlighted the use of ketamine as an adjunctive therapy in the management of tetanus when breakthrough seizures were refractory to diazepam [9]. Ironically, the Clostridial flaccid paralytic Botulinum toxin A has been used to treat residual contractures after cephalic tetanus [20].…”

Section: Discussionmentioning

confidence: 99%

“…These difficulties often precede respiratory problems where aspiration bronchopneumonia is a frequent and life-threatening complication [7,8]. The high mortality rate is related to frequent tetanic fits with laryngeal spasm and airway obstruction [9].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Diagnosis and Use of Glidescope<sup>t</sup><sup>m</sup> Video Laryngoscope for Cephalic Tetanus

Shulman¹,

Yasyulyanets²,

Kloser³

2013

OJAnes

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This case report describes the clinical characteristics and management of a 38-year-old man with cephalic tetanus. He presented with a massive facial infection after a dental procedure. After induction of anesthesia, cephalic tetanus was clinically diagnosed during induction based on the presence of a new facial nerve palsy and nuchal rigidity even after the administration of succinylcholine. The first attempt at intubation was unsuccessful with a Macintosh laryngoscope due to persistent nuchal rigidity and lockjaw despite the use of succinylcholine. Consistent with other reports, intubation was remarkably uncomplicated when the video laryngoscope was used. Postoperatively, the Clostridium tetani infection progressed to generalized tetanus and responded to supportive care. This case highlights the difficulties of diagnosis, and supports the utility of the Glidescope TM video laryngoscope in this unusual pathological condition.

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“…Although the benzodiazepines remain the primary sedative agent in use, variable success has been reported with other agents including ketamine, barbiturates, opioids and propofol. [12][13][14][15] Sedation with propofol infusion has been reported to control muscle spasms without the need for neuromuscular blocker agents. 15 However, given the potential adverse effects of propofol, including propofol infusion syndrome, such therapy cannot be recommended.…”

Section: Discussionmentioning

confidence: 99%