title: General anesthesia in tetanus patient undergoing emergency surgery: A challenge for anesthesiologist.
abstract: Tetanus is an acute often fatal disease produced by gram positive obligate anaerobic bacterium Clostridium tetani. Tetanolysin damages local tissue and provides optimal conditions for bacterial multiplication. It is therefore important to perform a wide debridement of any wound suspected of being a portal of entry for the bacteria. Little evidence exists to recommend specific anesthetic protocols. We encountered a child scheduled for fracture both bone forearm with developing tetanus. Initial management done with intravenous (i.v) diazepam, phenobarbitone, and metronidazole. After premedication with midazolam and fentanyl, induction was done by propofol 60 mg, vecuronium 2.5 mg, ventilated with O2+ N2O 50:50 with sevoflurane 2% and tracheal intubation was done with 5.5 ID cuffed PVC endotracheal tube. Anesthesia was maintained with sevoflurane 2% and vecuronium intermittently when required. Intraop vitals were stable. On completion of surgery, reversal given and patient was extubated uneventfully and shifted to recovery room. Little evidence exists to recommend specific anesthetic technique for tetanus patient posted for surgery. When present, obvious wounds should be surgically debrided. Ideally patients considered for surgery should undergo anesthesia and surgery before severe autonomic dysfunction develops. Most anesthetic managements are based on limited evidence. However, we used sevoflurane and vecuronium successfully, further study is needed to establish their efficacy and safety. Major challenges lie in the control of muscle rigidity and spasm, autonomic disturbances and prevention of complications.
authors.affiliation: Department of Anesthesiology and Critical Care, Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Mewat, Haryana, India.
authors.forename: Reena
authors.initials: R
authors.lastname: Mahajan
authors.affiliation: Department of Anesthesiology and Critical Care, Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Mewat, Haryana, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Anesthesiology and Critical Care, Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Mewat, Haryana, India.
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Singh
keywords: Tetanus; anesthesia; surgical procedure