Anesthesiology Residency and Fellowships

Global Health

Jesse Raiten, MD (Faculty, Anesthesia and Critical Care Medicine) - Blog Post 3

A 50 year old woman was admitted to our ICU after falling and badly cutting her knee. She started to experience generalized fevers, sweating, then trouble swallowing and spasms of her jaw. She had a severe case of tetanus. She was brought into the ICU where she was intubated due to progressive loss of mental status and worsening muscle spasms. We wanted to start muscle relaxants to stop the spasms, but we had used the hospital's last dose of muscle relaxant the day before when we intubated the neighboring patient. Without paralytic, we went with thiopental infusion, which seemed to help some. Her spasms were worsened by light, so her room was kept dark at all times. She stated to develop hematuria, probably from rhabdomyolysis, but her family couldn't afford blood work so we don't know how bad her renal failure became. I don't know if this patient survived, as I had to leave the country myself.

Tetanus is caused by the bacteria Clostridium tetani. Tetanus affects skeletal muscle and blocks release of GABA at neuromuscular junctions. There are approximately 30 cases/ year in the United States, and thousands across Africa and the developing world. The spasms are so severe they often cause bone fractures.