Magnesium as first line therapy in the management of tetanus: a prospective study of 40 patients.

Anaesthesia 2002 Aug;57(8):778-817 Attygalle D, Rodrigo N.

A prospective observational study was conducted to examine the efficacy and safety of magnesium sulphate for con­trol of spasms and autonomic dysfunc­tion in 40 patients with tetanus. Magnesium was infused intravenously, aiming to control spasms despite sup­pression of patellar reflex or respirato­ry insufficiency. Spasms were con­trolled in 38 of the 40 patients within a serum Mg2+ range of 2-4 mmol.l-1 with only two patients needing addi­tional neuromuscular blocking drugs. Seventeen of 24 patients (< 60 years) and six of 16 patients (.>/=60 years) did not require ventilatory support. Thirty-six patients were conscious and co-operative throughout their manage­ment. Sympathetic over-activity was controlled without supplementary sedation. Overall mortality was 12%; all five deaths were in patients >/= 60 years and no deaths were due to auto-nomic dysfunction. We recommend magnesium as possible first line thera­py in the routine management of tetanus.