title: Esmolol in a case of severe tetanus. Adequate haemodynamic control achieved despite markedly elevated catecholamine levels.
abstract: A patient with severe tetanus, who had a sympathetic crisis while sedated with 30 mg/h diazepam and 30 mg/h morphine, is described. Satisfactory control of the haemodynamic crisis was achieved with bolus doses of esmolol to a total of 180 mg. A disturbing finding was that although there was adequate control of the tachycardia and hypertension, arterial catecholamine levels remained markedly elevated. Adrenaline levels of 531 pg/ml (normal 10-110 pg/ml) and noradrenaline levels of 1,036 pg/ml (normal 100-500 pg/ml) were recorded when the patient had a systolic arterial pressure of 110 mmHg and a heart rate of 97/min. The implications of this finding are discussed.
authors.affiliation: Intensive Care Unit, Baragwanath Hospital and Department of Anaesthesia, University of Witwatersrand, Johannesburg.
authors.forename: S C
authors.initials: SC
authors.lastname: Beards
authors.forename: J
authors.initials: J
authors.lastname: Lipman
authors.forename: P A
authors.initials: PA
authors.lastname: Bothma
authors.forename: G M
authors.initials: GM
authors.lastname: Joynt
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D016292:Procedural Sedation / Q000379:methods; D016903:Drug Monitoring; D004837:Epinephrine / Q000097:blood*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D009638:Norepinephrine / Q000097:blood*; D011412:Propanolamines / Q000494:pharmacology / Q000627:therapeutic use*; D013742:Tetanus / Q000097:blood* / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D000319:Adrenergic beta-Antagonists; D011412:Propanolamines; C036604:esmolol; D009638:Norepinephrine; D004837:Epinephrine