Ketamine in the management of generalised cephalic tetanus.
BACKGROUND
Tetanus is a fatal infection caused by the neurotoxin tetanospasmin released by the vegetative spores of Clostridium tetani. The high mortality rate is related to frequent tetanic fits with laryngeal spasm and airway obstruction. Numerous anticonvulsants are in use, with varying efficacy in controlling fits. This case report highlights the use of ketamine as adjunctive therapy in the management of tetanus.


METHODS
A 20-year-old woman was admitted with a history of recurrent left ear pain, with bloody, purulent discharge, following a self-inflicted injury. She developed tetanic spasms 24 hours after admission. She had received no immunisations. A tracheostomy was established to relieve airway obstruction, and ketamine was added to the medication when breakthrough seizures were refractory to diazepam.


CONCLUSIONS
Ketamine is of proven safety as an anaesthetic agent, especially in cases in which an anaesthetist is not readily available. Its effectiveness in this case, in combination with diazepam, warrants further evaluation.
Dr Amadasun Ear Care Institute, Westend Hospital, Warri, Nigeria.
O
O
Obanor
H O
HO
Osazuwa
J E O
JE
Amadasun
D000927:Anticonvulsants / Q000008:administration & dosage*; D003975:Diazepam / Q000008:administration & dosage*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage*; D010032:Otitis Externa / Q000150:complications; D010035:Otitis Media, Suppurative / Q000150:complications; D012640:Seizures / Q000188:drug therapy; D016728:Self-Injurious Behavior / Q000150:complications; D013742:Tetanus / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
D000927:Anticonvulsants; D007649:Ketamine; D003975:Diazepam