Study about Otogenic Tetanus: An Approach towards Anesthetic Management

Introduction: Tetanus is a disease caused by endotoxins, tetanolysin and tetanospasmin released from Clostridium tetani which affects motor inhibitory neurons. Patients with tetanus may need emergency surgical intervention particularly in otogenic tetanus whish was secondary to foreign body in ear. The challenge for anaesthesiologist lies in control of autonomic dysfunction and muscle spasticity. Though general anaesthesia with nondepolarizing muscle relaxant is a better choice, use of sevoflurane as a sole anaesthetic agent for short surgical procedures can be used safely.

Objective: Aim of reporting this case is to discuss safety of sevoflurane as an anaesthetic agent for short surgical procedure in patient with tetanus. Also we want to discuss about challenges for anaesthetic management of patient with tetanus.

Case Report: We have covered the anaesthetic care of a 5-year-old boy with otogenic tetanus who was scheduled for the removal of a foreign body from his left ear in this article. With trismus, fever, muscle spasms, and difficulties swallowing for the previous four days, he was admitted to the infectious ward. He received 2500 IU/day of injectable immunoglobulin and a 5000 IU bolus of intramuscular tetanus toxoid. Cefixime and intravenous diazepam (6 mg every three hours) were administered. He was assigned to have a foreign body in his left ear removed on the second day of his admission. Premedicating with fentanyl and diazepam was administered intravenously. Sevoflurane, nitrous oxide, and oxygen were utilised for general anaesthesia. He experienced hypertension and tachycardia during and after surgery, which were managed with intravenous labetalol.

Conclusion: For surgical procedures like cleaning and debridement of wounds, removal of foreign bodies, or incision and drainage of abscesses in cases of tetanus, volatile anaesthetic agents can be utilised safely. However, it is advised to utilise nondepolarizing muscle relaxants. Sevoflurane was only utilised in one case, thus more research is needed to validate its efficacy and safety. Beta-blockers can be used to treat autonomic hyperactivity; intravenous labetalol is the preferred medication.