Dexmedetomidine sedation for the treatment of tetanus in the intensive care unit
Bursa, Turkey
* E-mail: nkelebek{at}uludag.edu.tr
Editor—In tetanus, the severe muscle spasms and autonomic instability affect the respiratory and cardiovascular systems, generally requiring treatment in the intensive care unit (ICU).1 2 Treatment is directed at suppressing rigidity, muscle spasms, and sympathetic activation, and controlling autonomic instability. A range of drugs including adrenergic blockers have been used.3–7 Dexmedetomidine is a lipophilic imidazole derivation with high affinity for 
2 adrenoceptors, having analgesic and anti-sympathetic properties.8 Dexmedetomidine, also, reduces plasma levels of catecholamines and maintains haemodynamic stability through its anti-sympathetic properties.6 8 Recently, infusion protocols lasting more than 24 h have been reported.9 10
We present our management of six cases of tetanus in whom dexmedetomidine infusion was given for 7 days, with particular reference to the effects of dexmedetomidine on muscle spasms and autonomic instability.
Six patients with tetanus (age 53–72 yr, three male, Apache score 5–19) were treated in our ICU (total stay 23–45 days, ventilated 12–37 days) with dexmetomidine plus the standard tetanus therapy, including antibiotic, antitoxin, and tetanus immunization. All patients were treated with same protocol. Dexmedetomidine infusion was started with a loading infusion of 1 µg kg–1 more than 10 min followed by a maintenance infusion rate of 0.2–0.7 µg kg–1 h–1. If supplementary sedation and muscle relaxation were required, diazepam was infused at 10–20 mg h–1, vecuronium was given as bolus at 0.1 mg kg–1, respectively. The level of sedation was measured hourly using the Ramsay sedation score. The haemodynamic variables before dexmedetomidine infusion, after loading dose, during dexmedetomidine infusion, and after discontinuation of dexmedetomidine infusion showed good stability (Table 1).
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To our knowledge, these are the first cases in which dexmedetomidine has been used in the treatment of tetanus. It appears that dexmedetomidine is a safe and effective option for these patients. Its administration did not fully control the muscle spasms but decreased their frequency and severity, and reduced the use of sedative, analgesic, and muscle relaxant drugs to control muscle spasms and cardiovascular instability. We believe that dexmedetomidine could be a useful adjunct in the management of tetanus and is worthy of further evaluation.
References
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