Autonomic dysfunction in tetanus – what lessons can be learnt with specific reference to alpha-2 agonists?
| Autor: | R. Hegde, Renae Deans, Jeffrey Lipman, Brett C. McWhinney, Andrew A. Udy, Janine Stuart, D. Freshwater-Turner, Robert J. Boots |
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| Rok vydání: | 2007 |
| Předmět: |
medicine.medical_specialty
Sympathetic nervous system Epinephrine Sedation Clonidine Norepinephrine Intensive care Anesthesiology medicine Humans Intensive care medicine Neuromuscular Blockade Tetanus business.industry Middle Aged medicine.disease Anesthesiology and Pain Medicine medicine.anatomical_structure Autonomic Nervous System Diseases Anesthesia Female medicine.symptom Antitoxin business Adrenergic alpha-Agonists Dexmedetomidine medicine.drug |
| Zdroj: | Anaesthesia. 62:1066-1070 |
| ISSN: | 1365-2044 0003-2409 |
| DOI: | 10.1111/j.1365-2044.2007.05217.x |
| Popis: | 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 alpha(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 alpha(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. |
| Databáze: | OpenAIRE |
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