ａｕｔｏｎｏｍｉｃ　ｏｖｅｒａｃｔｉｖｉｔｙに対しバルビツレート療法を行った重症破傷風の１例

DOI 被引用文献4件 参考文献16件

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  • Barbiturate Therapy in Severe Tetanus with Autonomic Overactivity.

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A 62-year-old woman with severe tetanus was admitted to our medical center. Initial symptoms upon admission were trismus, risus sardonicus and opisthotonus. Endotracheal intubation and mechanical ventilation were performed, and the administration of diazepam and pancuronium bromide was initiated to enable sedation and muscle relaxation. On the third day of hospitalization, abrupt fluctuations in the patient's blood pressure appeared, suggesting that the diazepam and pancuronium bromide did not stabilize hemodynamics. Barbiturate therapy was selected to reduce the autonomic overactivity that was causing the blood pressure fluctuations. A continuous infusion of 1 to 8mg/kg/hr of thiamylal sodium following an intravenous injection of 5mg/kg was successful in suppressing the blood pressure fluctuations. Serum thiamylal concentrations were measured throughout the period of hospitalization, and electroencephalograms (EEG) were intermittently monitored. When a burstsuppression pattern appeared on the EEG, the serum thiamylal concentration was approximately 15-20μg/ml. When the blood pressure fluctuations were suppressed, the serum thiamylal concentration exceeded 25-30μg/ml and the burst-suppression intervals on the EEG were lengthened. Thus, the reticular activating system and the autonomic nervous system were suppressed by different degree. Furthermore, the serum thiamylal concentration was closely related to the burst-suppression interval. These results indicate that EEG monitoring should be used to determine the optimal barbiturate dosage during barbiturate therapy for severe cases of tetanus.

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