- 期刊
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Otogenic Tetanus: A Challenge for Anesthetic Management
並列摘要
Introduction: Tetanus is a disease caused by endotoxins, tetanolysin and tetanospasmin released from Clostridium tetani which affects motor inhibitory neurons. The challenge for anesthesiologist lies in control of autonomic dysfunction and muscle spasticity. Case Report: In this article we have discussed anesthetic management of a s-year-old boy with otogenic tetanus posted for removal of foreign body in left ear. He was admitted in infectious ward with trismus, fever, muscle spasm and difficulty in swallowing for last four days. He received intramuscular tetanus toxoid, intramuscular immunoglobulin 5000 IU as bolus followed by 2500 IU/day. Intravenous diazepam 6 mg at every three hours and intravenous cefixime was given. On second day of admission he was posted for removal of foreign body in left ear. Intravenous diazepam and fentanyl were given as premedication and sevoflurane, nitrous oxide and oxygen was used for general anesthesia. During surgery and in postoperative period he developed hypertension and tachycardia, was treated with intravenous labetolol. Conclusion: In case of tetanus, volatile anesthetic agents can be safely used for surgical procedures like cleaning and debridement of wound, removal of foreign body or incision and drainage of abscess. However, use of nondepolarizing muscle relaxant is advisable. As we used sevoflurene in single case, further study is required for confirmation of its efficacy and safety. Autonomic hyperactivity can be managed with beta-blocker, intravenous labetolol is the drug of choice.