THE TREATMENT OF TETANUS

[摘要] The cases of two patients with tetanus have been presented in detail. One patient was severely ill and the other moderately so. Both were treated with large doses of antitoxin, curare, penicillin and sulfadiazine, tracheotomy and sedation. In the first case, sodium pentothal was used for continuous sedation for 15 days, supplemented with paraldehyde, chloral hydrate and sodium phenobarbital. In the second case sodium pentothal was needed only during the first three days of illness. Both patients recovered.Sodium pentothal was chosen because of its prompt action when given by vein, minimal toxicity to the liver, and noncumulative effect. Some degree of tolerance was noted and other sedatives were added to supplement its effect.D-tubocurarine chloride (Squibb) in wax and peanut oil (1 cc. = 30 mg. or 175 units) was given intramuscularly daily to aid in diminishing peripheral irritability and to supplement the sedative effect. A clear-cut evaluation of its beneficial effect is impossible because of the small series of cases and the number of other agents hitherto untried in this disease.Tracheotomy was used in these patients, prophylactically to prevent fatal laryngospasm, and therapeutically to provide an adequate airway and exit for accumulated thick gelatinous secretions. Few reports of its use in this disease have appeared in the literature. It was felt that it greatly benefitted these patients. Adequate, regular aspiration of the tracheotomy tubes was found to be mandatory while the patients were severely ill and while deep sedation was required. It was found that positive pressure oxygen could be administered through the tracheotomy tube for respiratory arrest while under curare and pentothal sedation. A simple apparatus for this purpose is presented.

[学科分类] 儿科学