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Autonomic dysfunction in tetanus – what lessons can be learnt with specific reference to alpha‐2 agonists?
Author(s) -
FreshwaterTurner D.,
Udy A.,
Lipman J.,
Deans R.,
Stuart J.,
Boots R.,
Hegde R.,
McWhinney B. C.
Publication year - 2007
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.2007.05217.x
Subject(s) - medicine , clonidine , sedation , tetanus , catecholamine , anesthesia , neuromuscular blockade , intensive care medicine , mechanical ventilation , blockade , antitoxin , alpha 2 adrenergic receptor , vaccination , immunology , toxin , receptor , biochemistry , chemistry
Summary Severe tetanus is seen infrequently in the developed world, but often requires intensive care support. Mechanical ventilation with neuromuscular blockade and heavy sedation, good wound care and prompt administration of antitoxin are important. The management of autonomic dysfunction remains challenging. We measured serum catecholamine levels in a patient with severe tetanus in whom autonomic crises were a major and persistent feature, and investigated the impact of sedatives plus α 2 ‐agonists on these levels. Serum adrenaline levels were elevated up to 100‐fold with clinically observed crises, although noradrenaline levels were much more difficult to interpret. There was no appreciable difference in catecholamine levels following administration of α 2 ‐agonists in the doses we used, although clonidine did allow easier control of crises with other agents. This case highlights some important lessons in the management of severe tetanus.