Document Detail

Management of sympathetic overactivity in tetanus with epidural bupivacaine and sufentanil: experience with 11 patients.
MedLine Citation:
PMID:  10507589     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine the efficacy and safety of epidural bupivacaine and sufentanil for the management of sympathetic overactivity in tetanus. DESIGN: Retrospective case review. SETTING: Sixteen-bed surgical intensive care unit in a tertiary care centre. PATIENTS: All patients referred to the unit during a 63-month period with the diagnosis of tetanus were included in the study. MEASUREMENTS AND MAIN RESULTS: All patients (n = 11) had severe tetanus and developed sympathetic overactivity, which was managed by epidural blockade. Three patients died, but there were no fatalities directly attributable to sympathetic overactivity. Before epidural blockade, the average difference between the mean maximum and mean minimum systolic blood pressures was 78 +/- 28 (so) mm Hg. After blockade, this difference was reduced to 38 +/- 15 (so) mm Hg (p < .0001). Similar significant reductions in diastolic blood pressure and heart rate were observed. The mean hourly infusion doses of bupivacaine and sufentanil were 17 mg and 21 microg, respectively. Midazolam was the principal adjunctive sedative agent and was used in all patients (mean dose, 9 mg/hr). Additional pharmacologic agents were necessary in two patients in whom epidural blockade alone was insufficient to control sympathetic overactivity. One patient developed renal failure and there were no instances of pneumothorax. One patient developed an epidural abscess of probable hematogenous origin, which was successfully treated without neurologic sequelae. CONCLUSIONS: Epidural blockade is effective in controlling sympathetic overactivity and the associated complications (renal failure, cardiac injury, and sudden death). Although a serious complication occurred in one patient, the efficacy of the technique deserves further validation.
S Bhagwanjee; A T Bösenberg; D J Muckart
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  27     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  1999 Sep 
Date Detail:
Created Date:  1999-10-15     Completed Date:  1999-10-15     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1721-5     Citation Subset:  AIM; IM    
Department of Anaesthesia, Surgical Intensive Care Unit, King Edward VIII Hospital, Congella, South Africa.
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MeSH Terms
Analgesia, Epidural* / adverse effects
Analgesics, Opioid / administration & dosage*
Anesthetics, Local / administration & dosage*
Bupivacaine / administration & dosage*
Drug Therapy, Combination
Hemodynamics / drug effects
Middle Aged
Retrospective Studies
Sufentanil / administration & dosage*
Sympathetic Nervous System / drug effects,  physiopathology*
Tetanus / drug therapy*,  physiopathology
Treatment Outcome
Reg. No./Substance:
0/Analgesics, Opioid; 0/Anesthetics, Local; 2180-92-9/Bupivacaine; 56030-54-7/Sufentanil
Comment In:
Crit Care Med. 1999 Sep;27(9):2025-6   [PMID:  10507637 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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