The treatment of severe tetanus generally requires prolonged mechanical ventilation. We describe two cases managed with continuous intrathecal infusion of baclofen via a subcutaneous tunnelled spinal catheter and an abdominal injection port. Baclofen, by diminishing spasms and spasticity, allowed reduced sedation and paralysis requirements. This potentially decreases the time and resources required for intensive care management. Complications include sedation, hypotension and CSF infection. After appropriate dose adjustment, baclofen improves the management of severe tetanus.
MullerH., BornerU., ZierskiJ., HempelmannG.. Intrathecal baclofen in tetanus.Lancet1986; 1: 317–318.
2.
SunK.O., ChanY.W., CheungR.T., SoP.C., YuY.L., LiP.C.. Management of tetanus: a review of 18 cases.J R Soc Med1994; 84: 135–137.
3.
LipmanJ., OhT.. Tetanus. In Intensive Care Manual.4th Ed.OhT.E., ed. Butterworth Heinemann1997; 423–427.
4.
TrujilloM.H., CastilloA., EspanaJ., ManzoA., ZerpaR.. Impact of intensive care management on the prognosis of tetanus. Analysis of 641 cases.Chest1987; 92: 63–65.
5.
Centers for Disease Control.Tetanus: United Stated, 1985–1986.MMWR Morb Mortal Wkly Rep1987; 36: 447–481.
6.
Centers for Disease Control.Tetanus: United States, 1987 and 1988.MMWR Morb Mortal Wkly Rep1990; 39: 37–41.
7.
DontaS.T.. Tetanus in Intensive Care Medicine.4th Ed.IrwinR.S., CerraF.B., RippeJ.M., eds, Lippincott-Raven Publishers, Philadelphia1999; 1187–1188.
8.
BrooksV.B., CurtisD.R., EcclesJ.C.. The action of tetanus toxin on the inhibition of motor neurones.J Physiol1957; 135: 655–672.
9.
DressnandtJ., KonstanzerA., WeinzierlF.X., PfabR., Klingel-höferJ.. Intrathecal baclofen in tetanus: four cases and a review of reported cases.Intensive Care Med1997; 23: 896–902.
10.
RomijnJ.A., van LieshoutJ.J., VelisD.N.. Reversible coma due to intrathecal baclofen.Lancet1986; 2: 696.
11.
BrockH., MoosbauerW., GabrielC., NecekS., BidalD.. Treatment of severe tetanus by continuous intrathecal infusion of baclofen.J Neurol Neurosurg Psych1995; 59: 193–194.
12.
SaissyJ.M., DemaziëreJ., VitrisM., SeckM., MarcouxL., GayeM., NdiayeM.. Treatment of severe tetanus by intrathecal injections of baclofen without artificial ventilation.Intensive Care Med1992; 18: 241–244.
13.
EngrandN., GuerotE., RouambaA., VilainG.. The efficacy of intrathecal baclofen in severe tetanus.Anesthesiology1999; 90: 1773–1776.
14.
MullerH., ZierskiJ., BörnerU., HemplemannG.. Intrathecal baclofen in tetanus.Ann New York Acad Sci1988; 531: 167–173.
15.
DemazièreJ., VitrisM., Marcoux, SaissyJ.M., SeckM., NdiayeM.. Intermittent intrathecal baclofen for severe tetanus.Lancet1991; 337: 427.
16.
SaissyJ.M., VitrisM., DemazièreJ., SeckM., MarcouxL., GayeM.. Flumazenil counteracts intrathecal baclofen induced central nervous system depression in tetanus.Anesthesiology1992; 76: 1051–1053.
17.
SilbertP.L., Stolp-SmithK.A.. Intrathecal baclofen in tetanus: alternative methods of administration.Anesthesiology1993; 79: 199–200.
18.
PellandaA., CaldiroliD., VaghiG.M., BonelliS.. Treatment of severe tetanus by intrathecal infusion of baclofen.Intensive Care Med1993; 19: 59.
19.
VitrisM., SaissyJ.M., DemazièreJ., SeckM., NdiayeM., GayeN., MarcouxL.. Treatment of severe tetanus by repeated intra-thecal injections of baclofen.Dakar Medical J1991; 36: 28–29.
20.
McLeanB.N.. Intrathecal baclofen in severe spasticity.Br J Hosp Med1993; 4: 263–267.
21.
Sallein-CauteB., LazorthesY., MonsarratB., CrosJ., BastideR.. CSF baclofen levels after intrathecal administration in severe spasticity.Eur J Clin Pharmacol1991; 40: 363–365.
