Post-neonatal tetanus: issues in intensive care management

Indian Journal of Pediatrics
S SinghiC Subramanian

Abstract

Tetanus is an acute neurological disease characterized by muscle rigidity and spasms, autonomic dysfunction and in severe forms requires respiratory and hemodynamic support. Though it is entirely preventable by immunization, it still occurs in developing countries causing significant morbidity and mortality. Intensive care management of tetanus is fraught with problems of ventilator-associated pneumonia, nosocomial sepsis and a variety of other complications. Various treatment protocols have been tried in managing diverse manifestations of severe tetanus but the consensus is yet to emerge. In this review we have discussed the pathophysiology, clinical features and management controversies and suggest on basis of our experience use of high dose diazepam (20-120 mg/kg/day) and vecuronium with mechanical ventilation if required for control of spasms, and early detection of autonomic dysfunction and use of propranolol, in our circumstances.

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Citations

Oct 4, 2003·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Gary D CenevivaDeborah Kees-Folts
Apr 9, 2015·Pediatric Emergency Care·Robert A Felter, Lauren E Zinns
Apr 12, 2014·Frontiers in Public Health·Adebola Emmanuel OrimadegunOlusegun Olusina Akinyinka
Feb 1, 2006·International Journal of Dermatology·Justin BrownNanette B Silverberg
Dec 26, 2015·Anesthesiology and Pain Medicine·Mohammad Taghi BeigmohammadiHamid Reza Amiri
May 2, 2017·Journal of Tropical Pediatrics·Suresh Kumar AnguranaKarthi Nallasamy

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