title: Titration of high dose sedation is effective in severe tetanus: a case report.
abstract: BACKGROUND
  Tetanus is a fatal infectious disease. It could cause typical signs like pain, headache, stiffness, and spasms of facial muscles as well as trunk and skeletal muscles. The symptoms are risus sardonicus, trismus and opisthotonus. How to control the spasticity and rigidity of muscles is still a problem. Our object is to raise the feasibility of titration of high dose sedatives in the management of severe tetanus.
  
  
  METHODS
  A 37-year-old woman was sustained a 2 cm wound in the right anterior part of chest. Then she developed progressive risus sardonicus, trismus and opisthotonus, elevated liver enzymes, creatine kinase, lactic acid and myoglobin. The patient was treated with continuous infusion of propofol (50-100 mg/h, 22 days) and midazolam (5-20 mg/h, 37 days) for sedation, vecuronium (1-6 mg/h, 25 days) for muscle relaxation. The symptoms of tetanus were controlled, and there were no side-effects appeared.
  
  
  CONCLUSIONS
  We report one case of severe tetanus. In this case, several types of sedative were administrated and most of them were high doses. The patient recovered while no complications remained. This case report indicated that combination and high dose of sedation for severe tetanus were feasible. We recommend this treatment as the guidance of similar patients.
authors.affiliation: Department of Critical Care Medicine, Zhong-Da Hospital, Southeast University Clinical Medical School Nanjing 210009, Jiangsu Province China. peterpan43100601@sina.com
authors.forename: Pan
authors.initials: P
authors.lastname: Chun
authors.forename: Huang
authors.initials: H
authors.lastname: Ying-Zi
authors.forename: Yang
authors.initials: Y
authors.lastname: Yi
authors.forename: Qiu
authors.initials: Q
authors.lastname: Hai-Bo