Ketamine in the management of generalised cephalic tetanus

Background: Tetanus is a fatal infection caused by the neurotoxin tetanospasmin released by the vegetative spores of Clostridium tetani. The high mortality rate is related to frequent tetanic fits with laryngeal spasm and airway obstruction. Numerous anticonvulsants are in use, with varying efficacy in controlling fits. This case report highlights the use of ketamine as adjunctive therapy in the management of tetanus. Case report: A 20-year-old woman was admitted with a history of recurrent left car pain, with bloody, purulent discharge, following a self-inflicted injury. She developed tetanic spasms 24 hours after admission. She had received no immunisations. A tracheostomy was established to relieve airway obstruction, and ketamine was added to the medication when breakthrough seizures were refractory to diazepam. Conclusion: Ketamine is of proven safety as an anaesthetic agent, especially in cases in which an anaesthetist is not readily available. Its effectiveness in this case, in combination with diazepam, warrants further evaluation.