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: Paul G Firth, James B Solomon, Laura L Roberts, Todd D Gleeson
• Journal: Anesthesia and analgesia (Anesth Analg) Vol. 113 Issue 3 Pg. 545-7 (Sep 2011) ISSN: 1526-7598 [Electronic] United States
• PMID: 21778337 (Publication Type: Case Reports, Journal Article, Research Support, U.S. Gov't, Non-P.H.S.)

Chemical References

• Anesthetics, General
• Neuromuscular Blocking Agents

Topics

• Adult
• Aged, 80 and over
• Airway Management (adverse effects, methods)
• Anesthetics, General (therapeutic use)
• Debridement
• Disasters
• Earthquakes
• Emergency Medical Services
• Fatal Outcome
• Haiti
• Humans
• Intercostal Muscles (physiopathology)
• Intubation, Intratracheal
• Male
• Neuromuscular Blocking Agents (therapeutic use)
• Palliative Care
• Positive-Pressure Respiration
• Ships
• Tetanus (complications, physiopathology, therapy)
• Treatment Outcome
• Trismus (microbiology, physiopathology, therapy)