title: Airway management of tetanus after the Haitian earthquake: new aspects of old observations.
abstract: Two men developed severe tetanus after the 2010 Haitian earthquake. They were admitted to the United States Naval Ship Comfort, a hospital ship sent to provide humanitarian relief. Severe masseter and intercostal muscle spasm impaired airway access and ventilation. Propofol and sevoflurane relieved the tetany, allowing airway control and ventilation without intubation or neuromuscular blocking drugs during wound debridement. Presynaptic impairment of inhibitory neurotransmitter release by tetanospasmin toxin is countered by enhancement of spinal cord postsynaptic inhibitory receptor activity by general anesthetics. Avoidance of tracheal intubation and mechanical ventilation during anesthesia may be desirable in the settings of limited resources in which tetanus usually presents.
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA. pfirth@partners.org
authors.forename: Paul G
authors.initials: PG
authors.lastname: Firth
authors.forename: James B
authors.initials: JB
authors.lastname: Solomon
authors.forename: Laura L
authors.initials: LL
authors.lastname: Roberts
authors.forename: Todd D
authors.initials: TD
authors.lastname: Gleeson
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D058109:Airway Management / Q000009:adverse effects / Q000379:methods*; D018681:Anesthetics, General / Q000627:therapeutic use*; D003646:Debridement; D004190:Disasters; D055866:Earthquakes; D004632:Emergency Medical Services; D017809:Fatal Outcome; D006205:Haiti; D006801:Humans; D007366:Intercostal Muscles / Q000503:physiopathology; D007442:Intubation, Intratracheal; D008297:Male; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use; D010166:Palliative Care; D011175:Positive-Pressure Respiration; D012767:Ships; D013742:Tetanus / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D014313:Trismus / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy
chemical_list: D018681:Anesthetics, General; D009466:Neuromuscular Blocking Agents